JOURNAL OF THE INTERNATIONAL SOCIETY FOR THE HISTORY OF ISLAMIC MEDICINE (ISHIM)
CHAIRMAN OF EDITORIAL BOARD Dr. Hajar A. HAJAR AL BINALI (Qatar)
EDITORS IN CHIEF Dr. Aysegül DEMIRHAN ERDEMIR (Turkey) Dr. Abdul Nasser KAADAN (Syria)
ASSOCIATE EDITORS Dr. Oztan ONCEL (Turkey) Dr. Sahin AKSOY (Turkey) Dr. Sharif Kaf AL-GHAZAL (England)
EDITORIAL BOARD Dr. Mahdi MUHAQAK (Iran) Dr. Husain NAGAMIA (USA) Dr. Nil SARI (Turkey) Dr. Faisal ALNASIR (Bahrain) Dr. Mostafa SHEHATA (Egypt) Dr. Rachel HAJAR (Qatar)
INTERNATIONAL ADVISORY BOARD Dr. Alain TOUWAIDE (Belgium) Dr. Taha AL-JASSER (Syria) Dr. Ahmad KANAAN (KSA) Dr. Rolando NERI-VELA (Mexico) Dr. David W. TSCHANZ (KSA) Dr. Zafar Afaq ANSARI (Malaysia) Dr. Abed Ameen YAGAN (Syria) Dr. Husaini HAFIZ (Singapore) Dr. Keishi HASEBE (Japan) Dr. Talat Masud YELBUZ (USA) Dr. Mustafa Abdul RAHMAN (France) Dr. Mohamed RASHED (Libya) Dr. Bacheer AL-KATEB (Syria) Dr. Nabil El TABBAKH (Egypt) Dr. Plinio PRIORESCHI (USA) Hakim Naimuddin ZUBAIRY (Pakistan) Hakim Syed Z. RAHMAN (India) Dr. Ahmad CHAUDHRY (England) Dr. Abdul Mohammad KAJBFZADEH (Iran) Dr. Farid HADDAD (USA) Dr. Nancy GALLAGHER (USA) Dr. Ibrahim SYED (USA) Dr. Riem HAWI (Germany) Dr. Henry Amin AZAR (USA) Dr. Esin KAHYA (Turkey) Dr. Gary FERNGREN (USA) Dr. Mamoun MOBAYED (England) JOURNAL OF THE INTERNATIONAL SOCIETY FOR THE HISTORY OF ISLAMIC MEDICINE (ISHIM)
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II JISHIM 2004, 3 JOURNAL OF ISHIM INSTRUCTIONS TO AUTHORS
1. Journal of the International Society for the History of Islamic Medicine (Journal of ISHIM), published twice-a-year, accepts material for publication as follows: Original Articles: Papers reporting a research in the History of Islamic Medicine and Islamic Medical Ethics. Letters to the Editor: Views on papers published in Journal of ISHIM, and other current topics and short reports of reader's own original findings. Letters should not exceed 400 words, 3 authors and 10 references. 2. Papers submitted to the journal are only accepted with the understanding that they are subjected to editorial revision and that they have not been or will not be submitted to any other journal. All authors are responsible for the scientific and ethical contents of their papers. 3. The journal's language is English. 4. The manuscript should be typewritten in an IBM compatible computer under Microsoft Word program. In addition to the form of the manuscript recorded into a disk/diskette, four copies of double spaced print-outs and figures and tables should be sent. The printed form should not be more than 12 pages. 5. The manuscript of a full paper should be arranged in the following order: Title page, abstract and key words, main text, acknowledge- ments, references, tables, figure legends and figures. All pages should be numbered consecutively. 6. TITLE PAGE: The title page should include a brief and descriptive title of the article the authors' names and academic degrees, hos- pital or academic affiliations, acknowledgements of grants and other support, and the name, address telephone/fax numbers and the e-mail address of the individual responsible for editorial correspondence. 7. ABSTRACTS and KEY WORDS: Each article should include brief English abstracts (not exceeding 200 words) stating the purpose(s) of the study, basic procedures, main findings, and the principle conclusions. Below the abstracts provide not more than 5 key words or short phrases. 8. MAIN TEXT: The main headings of the sections should be written in bold capital letters, and subheadings in bold italic lower case letters, except for initial letters. 9. REFERENCES should be numbered consequtively in the order in which they are first mentioned in the text and typed double-spaced. References used in the text should include the name of the first author followed by the other authors, title of the article, the year, the volume, the first and last page numbers. The names of the journals should be abbreviated according to the style used in the Index Medicus. ARTICLES IN JOURNALS: Meutler B, Cerami C. Cachectin: More than a tumor necrosis factor. N Engl J Med 1987; 316:379-85. CHAPTERS IN BOOKS: Arieff Al. Neurological manifestations of uremia. In: Brenner BM, Rector FC, eds. The Kidney: Philadelphia: WB Saunders, 1986:1731-56. 10. FIGURES and TABLES should be identified by arabic numerals (in parenthesis). The drawings should be submitted in original draw- ings by ink. The photographs should be printed in good contrast and be submitted unmounted. The letters and signs on all figures should be large enough to be legible after reduction. 11. Authors whose papers accepted for publication in the journal are encouraged to become subscribers. 12. Manuscripts should be sent to the editors in chief: Dr. Aysegül DEMÝRHAN ERDEMÝR 1)Director of Department of History of Medicine and Ethics, Faculty of Medicine, Uludag University, Bursa-TURKEY 2)P.K.166 Kadýkoy-lstanbul-TURKEY Fax:00-90-224-4419892 e-mail: [email protected]
Dr. Abdul Nasser KAADAN Head of History of Medicine Department, Institute for the History of Arabic Science, Aleppo University, The Secretary General of ISHIM, P.O.Box.7581 Aleppo-SYRIA Fax: 00-963-21-2248035 e-mail: [email protected] JOURNAL OF THE INTERNATIONAL SOCIETY FOR THE HISTORY OF ISLAMIC MEDICINE (ISHIM)
Vol 3 No 6 October 2004
CONTENTS
1 REVIEW Editorial 44 Aysegul DEMIRHAN ERDEMIR, Abdul Nasser KAADAN Medical Ethics in Medieval Islam Plinio PRIORESCHI
RESEARCH 49 3 Some Notes About the Influence of Arabian Medicine in The Influence of Islamic Philisophy and Ethics on the New Spain Development of Medicine During the Islamic Renaissance Rolando NERI-VELA Sharif Kaf AL-GHAZAL 52 10 Al-Razi and Gastrointestinal System Diseases Ahadith of the Prophet (s.a.w) on Healing in Three Things Radhi Jawad BAKIR (al-Shifa'fi Thalatha): An Interpretation Nurdeen DEURASEH 56 Control Project of Bejel (Endemic Syphilis) Disease in Iraq 17 Kathem K. AL-RUBIAY The School of Traditional Irainan Medicine: The Definition, Origin and Advantages. 60 Moshen NASERI, Mohammad Reza Shams ARDAKANI History of Endoscopy Mostafa SHEHATA 22 History of Genetics in Islam: About Colour, Stature and 64 Camels. The Story of Bejel Disease in Iraq: Haitham IDRISS Bejel (Endemic Syphilis) Among the Euphrates Arab Bedouins 28 Kathem K. AL-RUBIAY Albucasis and Extraction of Bladder Stone Abdul Nasser KAADAN 69 An Andalusian Muslim Scientist: Ibn al-Baytar 34 Rosanna GORINI A Medical Ethics Perspective to Laws in Public Health in Turkey 72 Ayþegül DEMIRHAN ERDEMIR Congress and Society News
38 74 Islamic Medical Ethics in Assisted Conception Scientific Events Farouk MAHMOUD
IV JISHIM 2004, 3 EDITORIAL
It is our pleasure to provide October 2004 Issue of the Journal of International Society for the History of Islamic Medicine (Journal of ISHIM). We know that Journal of ISHIM is an academic journal devoted to the History of Islamic Medicine and Ethics research and scholarship. Also, this issue like the earlier ones repre- sents diversified studies in the History of Islamic Medicine and Medical Ethics which stimulate thinking and raise certain questions. So, it also tries to provide solutions to thorny and sensitive problems and the ensuing understanding helps in enlarging one's perception and intellectual horizon. JISHIM is indexed to History Journal.De and IMEMR. Acknowledment about IMEMR is at the end of editorial. It is our pleasure to tell you that we have received the attached message from WHO, telling us that our ISHIM Journal is selected to be one of the sources of input of the IMEMR. This issue contains some scientific articles, in which, we can see both important biographies and valuable original studies on History of Islamic Medicine and Medical Ethics. These articles are from famous scholars of many countries of the world. So, this journal helps to the development of researches on the History of Islamic Medicine and Medical Ethics. Papers of this issue are seen as two types: Review and Research. After 14 papers, news of some scientific meetings are present. The first paper by Sharif Kaf AL-GHAZAL is on The Influence of Islamic Philisophy and Ethics on the Development of Medicine During the Islamic Renaissance. The second paper by Nurdeen DEURASEH is about Ahadith of the Prophet (s.a.w) on Healing in Three Things (al-Shifa'fi Thalatha): An Interpretation. Third paper by Moshen NASERI and Mohammad Reza Shams ARDAKANI is on The School of Traditional Irainan Medicine: The Definition, Origin and Advantages. The fourth paper by Haitham IDRISS is on History of Genetics in Islam: About Colour, Stature and Camels. The fifth paper by Abdul Nasser KAADAN is on Albucasis and Extraction of Bladder Stone. The sixth paper by Ayþegül DEMIRHAN ERDEMIR is on A Medical Ethics Perspective to Laws in Public Health in Turkey. The seventh paper by Farouk MAHMOUD is on Islamic Medical Ethics in Assisted Conception. The eighth paper by Plinio PRIORESCHI is on Medical Ethics in Medieval Islam. The ninth paper by Rolando NERI-VELA is on Some Notes About the Influence of Arabian Medicine in New Spain. The tenth paper by Radhi Jawad BAKIR is on Al-Razi and Gastrointestinal System Diseases. The eleventh paper by Kathem K. AL-RUBIAY is on Control Project of Bejel (Endemic Syphilis) Disease in Iraq. The twelft paper by Mostafa SHEHATA is on History of Endoscopy. The thirteenth paper by Kathem K. AL-RUBIAY is on The Story of Bejel Disease in Iraq: Bejel (Endemic Syphilis) Among the Euphrates Arab Bedouins. The last paper by Rosanna GORINI is on An Andalusian Muslim Scientist: Ibn al-Baytar. Wishing October 2004 Issue of the Journal of ISHIM, to be beneficial to all readers and colleagues.
Editors in Chief Dr. Aysegül Demirhan Erdemir Dr. Abdul Nasser Kaadan 2 JISHIM 2004, 3 The Influence of Islamic Philosophy and Ethics on The Development of Medicine During the Islamic Renaissance*
Sharif Kaf Al-GHAZAL*
* MD, MS, FRAS, Cert Plast (RCS), DM, Consultant Plastic, Reconstructive & Hand Surgeon - Bradford - England e-mail : [email protected]
Summary
I will take Medicine as an example and I will highlight the reasons of such good success of those Muslims in the field of Medicine and as medical ethics is one of the hottest issues in medicine these days and ethics can be described as a sub-branch of applied phi- losophy that seeks what are the right and the wrong, the good and the bad set of behaviours in a given circumstance. I will shed the light on the influence of Islamic medical ethics on the advancement of medicine during that Islamic golden era. Key Words; Islamic Medical Ethics, Islamic Philosophy, Islamic Renaissance.
Introduction ideas without angering religious fundamentalists, Although Islamic philosophy is of great diversity who were the church at that time. Without Islam's and richness, it is characterised by certain features example, the Renaissance thinkers may have present- that are of special significance for both an under- ed their ideas in a much more provocative form, set- standing of it and for an appraisal of its impact on the ting them back hundreds of years due to widespread world at large. hate, distrust and non-acceptance of what people would perceive to be overly radical ideas. One must remember that this philosophy existed at a time in which strict obedience of the Islamic reli- Secondly, Islamic philosophy always lead to one gion was customary. main conclusion, that the power of Allah (SWT) was supreme and that his words were the absolute truth. Islamic philosophy was also concerned with the basic issue of the harmony between human reasoning Thirdly, many of the ideas of Renaissance philos- and the revelations provided to the Muslims in the ophy are based on ancient Greek, Persian and Indian holy Quran. As a result all sorts of sciences were texts, which the Muslims translated, as well as the studied in order to determine that relation between philosophy of the Muslims themselves. The Muslims the universe and the human being in one hand and the were responsible for creating the foundation for the creature of that universe, Allah (SWT), on the other "building" of philosophy that the Renaissance hand. thinkers would later "construct". The impact of Islamic philosophy on the Finally, Islamic philosophy greatly encouraged Renaissance was enormous. First and foremost, science, particularly mathematics and medicine. Islamic philosophy originates from a time when Without philosophy's constant encouraging of scien- Islam had a great influence on everyday life. The tific development, the large number of discoveries mere fact that Islamic philosophy was able to operate made by the Muslims may never have taken place. in such a fundamentalist environment greatly effect- I will take Medicine as an example and I will ed the Renaissance for it served as an example the highlight the reasons of such good success of those thinkers of that time - how to present new, radical Muslims in the field of Medicine and as medical
JISHIM 2004, 3 3 Sharif Kaf Al-GHAZAL THE INFLUENCE OF ISLAMIC PHILOSOPHY AND ETHICS ON THE DEVELOPMENT OF MEDICINE DURING THE ISLAMIC RENAISSANCE ethics is one of the hottest issues in medicine these 2. The general philosophy in Islamic medicine is days and ethics can be described as a sub-branch of that the healer is Allah (SWT) and the doctor is the applied philosophy that seeks what are the right and instrument that Allah uses to heal the people. The the wrong, the good and the bad set of behaviours in doctor-patient relationship is stronger in Islam than it a given circumstance. I will shed the light on the is in modern medicine as he has responsibilities influence of Islamic medical ethics on the advance- which he will be asked about them by Allah in the ment of medicine during that Islamic golden era day of judgment. The relationship now in the west is medical/legal. The emphasis has become one that has slipped into more materialism. Because the relationship between doctor and patient has become one that is based more on money than before, the level of trust has been dec- imated between the doctor and his/her patients. 3. There is no censorship in Islam on scientific research, be it academic to reveal the signs of God in His creation, or applied aiming at the solution of a particular problem. So, what are the factors behind the success of the Muslim scientists and how Islamic philosophy Freedom of scientific research shall not cause encouraged them to be leaders in many branches harm to any human being or even subjecting him to of science, especially in the medical sciences definite or probable harm, with holding his therapeu- tic needs, defrauding him or exploiting his material I. Islam and the Promotion of Science need. As the Moslems challenged the civilized world at Freedom of scientific research shall not entail cru- that time, they preserved the cultures of the con- elty to animals, or their torture. Suitable protocols quered countries. On the other hand, when the should be laid upon for the uncruel handling of Islamic Empire became weak, most of the Islamic experimental animals during experimentation. contributions in art and science were destroyed. This 4. Islam provides laws and a basis for the protec- was done by the Mongols who, out of barbarism, tion and safeguarding of the human body as well as burnt Baghdad (1258 A.D.), and by the Spaniards, the spirit and seeks to prevent any hindrance to either who out of hatred, demolished most of the Arabic body or soul. Holy Quran says: "and whoever saves heritage in Spain. The difference between the Arabs a life it would be as if he saved the life of all the peo- and these was the teachings of Islam. These teachings ple" 5- 32 . Perhaps there is no better way to imple- had played extensive roles by: ment this concept than in the area of saving lives by 1. Stressing the importance and respect of learn- transplanting donated organs to replace failing vital ing. For example, the first word revealed to prophet ones. Mohammad (PBUH) was "Read". In that time, a cap- And the Hadith of the Prophet (PBUH) "Whoever tured enemy was freed if he paid a ransom or taught helps a brother in difficulty, God will help him ten Muslims writing and reading. In the holy Quran, through his difficulties on the Day of Judgement." the importance of knowledge has been repeatedly stressed as it says "Say (unto them, O Muhammad): Islam provides rights and protections to all human Are those who know equal with those who do not beings at every stage and area of life. The holy Quran know?" 39-9. Prophet Mohammad (PBUH) stressed states : "Do not kill your children on account of learning by saying : "One hour of teaching is better want or poverty, We provide them sustenance for than a night of praying." you and for them." 6:151.
4 JISHIM 2004, 3 THE INFLUENCE OF ISLAMIC PHILOSOPHY AND ETHICS ON THE Sharif Kaf Al-GHAZAL DEVELOPMENT OF MEDICINE DURING THE ISLAMIC RENAISSANCE 5. Islam developed in Muslims the respect of for the study of medicine and chemistry. He studied authority and discipline. For example, realizing the medicine under John the Grammarian of Alexandria, scourges and terror of plague, prophet Mohammad and chemistry under Merrinos the Greek. He also (PBUH) decreed that "No man may enter or leave a encouraged several Greek and Coptic medical books town in which plague broke out." And to make this to be translated into Arabic. law all the more binding and effective, he promised The Abbasi Caliphs during the 8th century encour- the blessing of heaven to those who die of plague by aged the Persian physicians to translate into Arabic stating that if a man died of plague he would be con- the medical knowledge therein, to build medical cen- sidered a martyr. Thus prophet Mohammed (PBUH) tres in Baghdad, the capital of their empire, and to run laid for the Muslims the laws governing them and newly built hospitals. With further expansion east, the made it work. Arabs through contacts with India and China, brought 6. Tolerated other religions. The Islamic religion ideas and methods, not only in medicine, but also in recognizes Christianity and Judaism and considers mathematics, chemistry, philosophy, etc. their followers to be people with holy books like Muslims. Moreover, they candidly treated the Jews at Characteristic Features of Hospitals in an era when the latter were persecuted in Europe. Dr. the Islamic Civilization Jacob Minkin, a reputable Rabbi and scholar says "It The Muslims played developed what would was Mohammadan Spain, the only land of freedom the become the world's first hospitals. The Muslims Jews knew in nearly a thousand years of their disper- eventually constructed 34 of these hospitals through- sion, while during the Crusades, the armoured Knights out their empire. These hospitals had different wards of the Cross spread death and devastation in the Jewish for the treatment of different diseases, special quar- communities of the countries through which they ters for the insane, outpatient departments for the passed, Jews were safe under the sign of the Crescent. treatment of minor injuries and dispensaries, which They were not only safe in life and possessions, but provided virtually every kind of remedy then known. were given the opportunity to live their own lives and develop a culture. So, there were many Christian and These hospitals had specific characteristics: Jewish physicians who contributed in the Islamic ren- a. Secular: Hospitals served all peoples irrespec- aissance (e.g. Jibra'il Ibn Bakhtashoo'e , Youhanna Ibn tive of color, religion, or background. They were run Masawaih, Ishaq Ibn Honain and Ishaq Ibn Moosa) . by the government rather than by the church, and They were part of that "Golden Ages" ! their Directors were commonly physicians assisted by persons who had no religious color. In hospitals, II. The Attitude and Contribution of the State physicians of all faiths worked together with one aim The Islamic empire in the early 8th century were in common: the well-being of patients. the inheritors of the scientific tradition of late antiq- b. Separate wards and nurses: Patients of different uity. They preserved it, elaborated it, and finally, sexes occupied separate wards. Also different diseases passed it to Europe. At this early date, the Islamic especially infectious ones, were allocated different dynasty of the Umayyads showed an interest in sci- wards. Male nurses were to take care of male patients, ence. It was the century that were, for Europeans, the and female ones were take of the female patients. Dark Ages, were, for Muslim scholars, centuries of philosophical and scientific discovery and develop- c. Proper records of patients: For the first time in ment. The Arabs at the time not only assimilated the history, these hospitals kept records of patients and ancient wisdom of Persia, and the classical heritage their medical care. of Greece, but adapted their own distinctive needs d. Baths and water supplies: Praying five times a and ways of thinking. day is an important pillar of Islam. Sick or healthy, it One of the early Umayyad princes, Khalid Ibn is an Islamic obligation; of course physical perform- Yazid (end of the 7th century), gave up his treasure ance depends on one's health, even he can pray while
JISHIM 2004, 3 5 Sharif Kaf Al-GHAZAL THE INFLUENCE OF ISLAMIC PHILOSOPHY AND ETHICS ON THE DEVELOPMENT OF MEDICINE DURING THE ISLAMIC RENAISSANCE laying in bed. Therefore, these hospitals had to pro- ing medical students, interchanging medical knowl- vide the patients and employees with plentiful of edge, and developing medicine as a whole. To the clear water supply and with bathing facilities. main hospitals, there were attached expensive libraries containing the most up-to-date books, audi- e. Practicing physicians: Only qualified physi- toria for meetings and lectures, and housing for stu- cians were allowed by law to practice medicine. In dents and house-staff. 931 A.D., the Caliph Al-Mugtadir from the Abbasid dynasty, ordered the Chief Court-Physician Sinan Ibn-Thabit to screen the 860 physicians-of Baghdad, and only those qualified were granted license to prac- tice. It is worth mentioning also that the physicians in that era earned a high prestige. Although anyone, irrespective of his social status, can study medicine, yet the route was long and tedious. He had to finish Islamic studies, philosophy, astronomy, art, chem- istry, etc. before being accepted as a medical student. h. Rulers' involvement in building hospitals: The Therefore, the physician was an an educated person Caliphs of the Islamic empire built magnificent hos- who had wisdom and knowledge. In fact, the Arabic pitals for religious reasons, as Islam teaches that translation of a physician is "Hakim" which means money spent on charity is a good investment for sage. In the 9th and 10th century, the Court- Judgment Day; and for political reasons when they Physician was in the protocol ahead of the Chief- showed their people that they cared, and were inter- Justice. Many eminent physicians, as we will discuss ested in them. Whatever the motive of the ruler, the later, showed enough talent, social knowledge, polit- population benefited and good hospitals were estab- ical capabilities, and wisdom to be appointed by the lished. Caliphs as prime ministers. Owing to the high pres- tige and connections of physicians, generous funds i. Adequate financing to run the hospitals: The for hospitals were easily obtained. rulers set aside generous funds to run these hospitals. There was a special system called Al-Waqf. A person f. Medical Regulation: Before the Muslims, med- can donate part or all of this wealth to charity. The gov- icine had been an unregulated profession, where one ernment takes care of such a donation, and its revenues could easily fall into the hands of an unqualified doc- help to maintain and build mosques, hospitals, and tor. However, the Muslims' introduction of regulation schools. Another source of funds and an important pil- ensured that all doctors were qualified . Prophet lar of Islam is Al-Zakat (2.5% of property value). Mohammad (PBUH) said (He who practices medi- cine and is not therein versed is deemed like a guar- antor). The regulations also ensured that doctors did not cheat their patients when it came to drug compo- sition. This concept affected the Renaissance's physi- cians for it set an example for them, leading them to found various medical associations and guilds for the purpose of regulating their profession too . Hence, one could say that the Muslims' regulation of medi- cine lead to a safer and more professional medical institution during the Renaissance, which doubtlessly saved countless lives that would have been lost due to medical incompetence. g. Rather medical schools: The hospital was not Thus, the main Arabian hospitals were models for only a place for treating patients, but also for educat- medieval hospitals built later in Europe. They were
6 JISHIM 2004, 3 THE INFLUENCE OF ISLAMIC PHILOSOPHY AND ETHICS ON THE Sharif Kaf Al-GHAZAL DEVELOPMENT OF MEDICINE DURING THE ISLAMIC RENAISSANCE rather medical schools to which those seeking was the first differentiation of a specific disease from advanced medical knowledge, from the East or West, many eruptive fevers that assailed man. His methods attended. of differentiation were to be utilized by the physi- cians of the Renaissance when they attempted to do III. Islamic Physicians the same with other diseases hundreds of years later. Medicine in Islam passed through three stages: Additionally, his treatise of smallpox was used by Renaissance physicians to treat cases of this disease 1. The first stage is the stage of translation of for- throughout the Renaissance, saving countless lives. eign sources into Arabic. It extended mainly during His works on hygiene set an example that the seventh and eighth centuries. Renaissance physicians followed and attempted to 2. The second stage is the stage of excellence and improve on. The result was medical procedures that genuine contribution in which the Islamic physicians were much more hygienic, again saving countless were the leaders and the source of new chapters to lives that would have been lost through infection. medicine. This stage extended during the ninth Finally, his monumental book encyclopaedia (Al through the thirteenth centuries. Hawi) offered striking insights for its time, and it had a huge impact shaping European medicine during the 3. The third stage is the stage of decline where Renaissance and years after. medicine, as well as other branches of science, became stagnant and deteriorated. The stage started Ibn Sina (Avicenna), honored in the West with the mainly after the thirteenth century. title of "Prince of Physicians". Ibn Sina's works also had a significant impact on the Renaissance. Firstly, During the first stage, Syrian and Persian scholars his Canon of Medicine was the most widely studied did a marvellous job by translating honestly the work of medicine in Europe from the 12th to the 17th ancient literature from Greek and old Syrian into century. It also served as a chief guide to medical sci- Arabic. They translated different branches of science ence to European universities. Needless to say, the including philosophy astrology, and medicine. The impact of this book on Renaissance science was enor- works of Hippocrates, Aristototle and Galen were mous, as it was their primary source of medical infor- among those translated from Arabic, the classic mation. Ibn Sina's discovery that certain diseases Greek literature was translated into Latin, then into could be spread through water and soil affected the Greek because most of the original scripts were lost research of many Renaissance physicians. Since they and the only source was the Arabic translation. If the knew how the disease was transmitted, if made their Arabs did only one thing, namely, preserving the job of finding cures for diseases much easier. It also ancient literature and handing it honestly to Europe, provided a base for their studies into how disease was that would have been a sufficient contribution in spread. itself. The Moslem rulers encouraged translation, e.g. Caliph Al-Mamun Al-Abbassi paid the translator the Ibn Al Nafis who discovered the pulmonary circu- weight of his translation in gold. Among the eminent lation which was re-discovered by modern science physicians who took part in the first stage were Jurjis after a lapse of three centuries. He was the first to lbn-Bakhtashoo, his grandson Jibrail, Youhanna Ibn- correctly describe the constitution of the lungs and Masawaih, and Honain Ibn-Ishaq; most of them were gave a description of the bronchi and the interaction Christians, yet they were respected and well treated between the human body's vessels for air and blood. by the Moslem rulers. Also, he elaborated the function of the coronary arteries as feeding the cardiac muscle. The Impact of Some Muslim Physicians Al Zahrawi (Abulcasis) The spanish-born Muslim Al Razi (Rhazes) was said to have written more in the 10th century who wrote about the science of than 200 books, with 100 of these books on medicine. surgery. He was able to perform remarkably complex Al Razi's work had a significant impact on the operations for his time, including cranial and vascu- Renaissance. Firstly, Razi's discovery of smallpox lar surgery, operations for cancer, delicate abdominal
JISHIM 2004, 3 7 Sharif Kaf Al-GHAZAL THE INFLUENCE OF ISLAMIC PHILOSOPHY AND ETHICS ON THE DEVELOPMENT OF MEDICINE DURING THE ISLAMIC RENAISSANCE surgery involving the use of drainage tubes, and the not hesitate to ask forgiveness if he has made amputation of diseased arms and legs. an error . He should be forgiving and never seek revenge . He should be friendly and Ibn Juljul of Cordoba in 943 became a leading peacemaker . He should avoid predicting physician at the age of 24, compiled a book of special whether a patient will live or die, only Allah treaties on drugs found in al-Andalus. knows He ought not loose his temper when Ibn-Masawayh wrote the oldest systematic his patient keeps asking questions, but should treaties on ophthalmology. The book, titled al-Ashr answer gently and compassionately He Maqalat fi al-'Ayn (the ten treaties of the eye) was the should treat alike the rich and the poor, the earliest existing text book of ophthalmology. master and the servant . God will reward him if he helps the needy He should be punc- tual and reliable He should not wrangle about his fees. If the patient is very ill or in an emergency, he should be thankful, no matter how much he is paid He should not give drugs to a pregnant woman for an abortion unless necessary for the mother's health. . He should be decent towards women and should not divulge the secrets of his patients He should speak no evil of reputable In the curative use of drugs, some amazing men of the community or be critical of any advances were made by the Muslims. They have one's religious belief He should speak well established the first apothecary shops, and founded of his colleagues . He should not honor him- the earliest school of pharmacy. The Muslims were self by shaming others . " also one of the first people to use anesthetics to ren- So, although Bioethics took birth and developed der patients unconscious. in western world, consequently most of the philo- sophical bases of bioethics are derived from concepts IV. Medical Ethics in Islam of western philosophies. In last 25 years the Islamic Specific works written by Muslim physicians on world has felt the need to introduce courses in the subject of ethics and medicine include the sub- Islamic bioethics in order to study the Islamic ethics stantive work was a well respected specialty and its in the medical field which has been established hun- leaders kept it this way by laying down proper ethics. dreds of years ago and also to appreciate what shari- Ishaq ibn 'Ali al-Ruhavi (9th century CE) wrote a a'h has to say about the predominant bioethical issues book entitled Adab al-Tabib or 'The Ethics of the (informed consent, abortion, IVF, euthanasia, and Physician'. Al-Tabari, the chief physician in 970 organ transplantation, and many others). It is essen- A.D., described also the Islamic code of ethics in his tial that one is introduced to the tenets of Islamic book Fardous Al Hikma (The paradise of wisdom) legal philosophies and theories. stressing on good Personal characters of the physi- At the end of this article It is worth mentioning cian, the physician's obligations towards his patients, that the First International Conference on Islamic community and colleagues . He stated: Medicine held in Kuwait in January 1981 published " The physician should be modest, virtu- the oath of Muslim doctor which says : ous and merciful He should wear clean "I swear by God ...The Great .. To regard clothes, be dignified, and have well- groomed God in carrying out my profession To protect hair and beard . He should select his compa- human life in all stages and under all circum- ny to be persons of good reputation . He stances, doing my utmost to rescue it from should be careful of what he says and should death, malady, pain and anxiety. . To keep
8 JISHIM 2004, 3 THE INFLUENCE OF ISLAMIC PHILOSOPHY AND ETHICS ON THE Sharif Kaf Al-GHAZAL DEVELOPMENT OF MEDICINE DURING THE ISLAMIC RENAISSANCE peoples' dignity, cover their privacies and lock Dark Middle Ages in Europe. Journal of the International up their secrets ... To be, all the way, an instru- Society for the History of Islamic Medicine (ISHIM). 2003; 1(3):37-38. ment of God's mercy, extending my medical 5. Al-Ghazal SK.: The valuable contributions of Al-Razi care to near and far, virtuous and sinner and (Rhazes) in the history of pharmacy during the middle ages. friend and enemy. .. To strive in the pursuit of Journal of the International Society for the History of knowledge and. harnessing it for the benefit Islamic Medicine (ISHIM). 2003 2(4):9-11. but not the harm of Mankind. .. To revere my 6. Al-Ghazal SK.: Medical Ethics in Islamic History At a teacher, teach my junior, and be brother to Glance. Journal of the International Society for the History of Islamic Medicine (ISHIM). 2004; 3(5): 12-13. members of the Medical Profession .. and to 7. Al-Ghazal SK. Do medical ethics need an Islamic renova- join in piety and charity To live my Faith in tion? Interview with Islam On Line (http://www.islamon- private and in public, avoiding whatever blem- line.net/livedialogue/Browse.asp?hGuestID-mIW3Gj). ishes me in the eyes of God, His apostle and 8. Al-Ghazal SK. Islamic Medicine On-Line. (http://www. my fellow Faithful And may God be witness islamicmedicine.org). to this Oath." 9. Martin MA. In: Hayes JR ed. The Genius of Arab Civilisation, 2nd edition. London, 1983. 10. The Oath of Muslim Physician. Published in the Islamic REFERENCES Organization for Medical Science web site. (http://www. islamset.com/ethics/code/cont2.html). 1. Hamarneh SNY.: The Physician and the Health Professions 11. Butt N. Science and Muslim Societies. London: Grey Seal, in Medieval Islam. Acad. Med. 1971; 47:1088-1110. 1991:37-88. 2. Al-Ghazal SK.: The Origin of Bimaristans (Hospitals) in 12. Sheikh A, Gatrad AR, Dhami S.: Culturally sensitive care Islamic Medical History. Journal of the International for the dying is a basic human right. BMJ 1999; 319: 1073. Society for the History of Islamic Medicine (ISHIM). 2002; 13. Al-Sayyad I. Islamic approach to Medicine (Translated by 1(1): 41-44. M Madi ). 3. Al-Ghazal SK.: The Discovery of the Pulmonary 14. Hitti KP. History of the Arabs, 10th edition, London: Circulation-Who Should Get the Credit: Ibn Al-Nefis or Macmillan, 1970. William Harvey?. Journal of the International Society for the 15. Levy M. Medical Ethics of Medieval Islam with Special History of Islamic Medicine (ISHIM). 2002; 1(2):46-48. Reference to Al-Ruhawis. Practical Ethics of the Physician. 4. Al-Ghazal SK.: Al-Zahrawi (Albucasis)-A Light in the May 1967; A. Sheikh, A R Gatrad, S Dhami 57 Part-3.
JISHIM 2004, 3 9 Ahadith of the Prophet (s.a.w) on Healing in Three Things (al-S hifa fi Thalatha): An Interpretational*
Nurdeen DEURASEH*
* Dr. Department of Govemment & Civilization Studies, Faculty of Human Ecology, University of Putra Malaysia 43400 UPM Sergand, Selangor - Malaysia e-mail : [email protected], [email protected]
Summary Attempts will be made to interpret and evaluate the authentic ahadith of the Prophet Muhammad (s.a.w) on healing in three things (al-Shifa' fi Thalatha) namely by a gulp of honey (al-`asal), cupping (al-hijamah) and cauterization (al-kayy). The study is extreme- ly interesting and important because it throws light on the conditions of Muslims in the time of Prophet (s.a.w) i.e., how did they treat the disease, if somebody was sick. It seems from the ahadith on healing in three things that the treatment of diseases, in the time of the Prophet (s.a.w), was also based on the cause of disease and thus, given the level of scientific knowledge that existed at that time. Several companions of the Prophet (s.a.w) had been successfully treated of certain disease after following the medical advices and instructions of the Prophet (s.a.w). Key Words; Medicine of the Prophet; Healing is in three things: a gulp of honey (al-`asal), cupping (al-hijamah) and cauterization (al-kayy).
Is Healing in Three Things? three methods of healing namely a gulp of honey, The ahadith of the Prophet (s.a.w) on healing in cupping, and branding with fire (cauterizing). In try- three things were reported by Imam Bukhari (194- ing to answer the question, why did the Prophet 256/810-870), in his Kitab al-Tibb (book of medicine), (s.a.w) mention only three methods of healing?, Ibn Bab al-Shifa' fi Thalatha (chapter on healing is in three Hajr clarified that the Prophet (s.a.w) mentioned only things) (1). Two of them were reported by Ibn Abbas three methods of healing mainly because they were and another was by Jabir b. Abd Allah. First: "Healing usul al-`ilaj, the principle of treatment of disease. In is in three things: a gulp of honey, cupping, and brand- addition, it was widely known among the Arab in that ing with fire (cauterizing), however, I forbid my fol- time. It is possible that this belief was the result of lowers to use branding with fire (cauterization) (al- Muslim's discoveries during that time that the cause Shifa' fi thalatha: sharbat `asal, wa shartah mihjam, of disease was mainly blood (damawi) or yellow bile wa kayyah nar, wa anha ummati `an al-kayy)." Second: (safrawi) or black bile (sawdawi) or phlegm (balghi) "Healing is in three things: cupping, a drink of honey (2). This implies that the Arab in that time viewed the and cauterization (branding with fire) but I forbid my nature of disease in terms of philosophy and looked followers to use cauterization (al-Shifa' fi Thalatha: fi upon it as a disturbance in the equilibrium of the Shartati Mihjam, aw Sharbat Asal, aw Kayy bi Nar, wa body's blood, yellow bile (safrawi), black bile (saw- Anha Ummati an al-Kayy)." In another version, it was dawi) and phlegm (balghi). Thus, the disease, which narrated by Jabir bin Abdullah that he heard the is caused by one of them should be treated either by Prophet said: "If there is any healing in your medicines, hijamah (taking the impure blood from the body) or then it is in cupping, a drink of honey or branding with honey. If we failed to treat a disease by the mentioned fire (cauterization) that suits the ailment, but I don't like method, then, it must be treated by cauterization or to be (cauterized) branded with fire." (1). surgery as in our time. The latter could not be more In his interpretation of the above ahadith, Ibn Hajr than a last option to which physicians had to consid- al-`Asqalani (773-852/1372-1449) reminded us that er when a gulp of honey, cupping and dietic and phar- the treatment of disease does not predestine only maceutical treatments failed.
10 JISHIM 2004, 3 AHADITH OF THE PROPHET (S.A.W) ON HEALING IN THREE THINGS Nurdeen DEURASEH (AL-S HIFA' FI THALATHA): AN INTERPRETATIONAL* When we pondering this method of treatment of A. Honey: Healing for Men disease, one finds that the treatment of disease, in the (Shifa' li al-Nas) time of Prophet (s.a.w), was basically according to the nature of disease and to know its treatment, they In Islamic medical system, as in most other med- were advised to know its cause and symptom ical systems, honey is considered as healthy drink. (ma`rifatuhu bitahqiq al-sabab wa al-alamah). That We are not surprising Imam Bukhari entitled chapter four of his Kitab al-Tibb (book of medicine) as "al- is why before commenting the method of healing as Dawa' bi al-Asal wa Qawlihi Ta`ala 'Fihi Shifa li al- highlighted in the hadith, Ibn Hajr had to clarify two Nas (treatment with honey and the statement of types of diseases namely material disease (mard Allah: where is healing for men)." At this place, madiyyah) and non material disease (mard ghayra Imam al-Bukhari mentioned three ahadith on honey madiyyah). The former is referred to the disease together with its value which is emphasized in many caused by hotness (al-hararah), coldness (al-bari- verses of the Quran. In Surah al-Nahl verses: 68-69, dah). The latter is divided into wet (rutbah), dry Allah (s.w.t) describes honey as Shifa' li al-Nas: (yabisah) and compound (murakkabah). The non "And thy Lord taught the bee to build its cells in hills, material disease, according to Ibn Hajr, is treated by on trees, and in (men's) habitations; Then to eat of all what has been said in the hadith 'fever is from the the produce (of the earth), and find with skill the spa- heat of Hell, so abate fever with water.' (2). cious paths of its Lord: there issues from within their In the light of this evidence, we feel much more bodies a drink of varying colors, wherein is healing confidence to say that the body and the soul of for men: verily in this is a sign for those who give mankind have the possibility to be healthy or sick, bal- thought." In view of this benefit, it is worth to men- anced or imbalanced. Imbalance of the body is like tion one of the most well known hadith, in regard to fever, headache and other physical illness, while that the medical benefits of honey, that has been men- of the soul is like anger, anxiety, sadness and similar tioned by Imam Bukhari in his Sahih Bukhari in symptoms. The former diseases should be treated Kitab al-Tibb (book of medicine), Bab al-Dawa bi al- through the medical methods involving the use of Asal waqawl Allah Ta`ala fihi Shifa li al-Nas (chap- honey, cupping and cauterization, while the latter ter on treatment with honey and the statement of should be treated by spiritual method of treatments. In Allah: where is healing for men). Accordingly, the certain cases, one was encouraged to use the spiritual Prophet (s.a.w) said: "A man came to the Prophet and treatment rather than physical treatment for many rea- said: "My brother has some abdominal trouble." The sons. First, in seeking to be healed from the disease of Prophet (s.a.w) replied to him "let him drink honey." the body, the patients bear the bitterness of medica- The man came for the second time and the Prophet tions, the suffering of cauterization as well as spending replied to him, 'let him drink honey." He came for the large sums of money for medical treatment and care. third time and the Prophet replied, "let him drink On the other hand, the care and refinement of the soul honey." He returned again and said, "I have done which is far more important, is more pleasant and that". The Prophet (s.a.w) then said, "Allah has said rewarding and less costly to treat and restore (3) . the truth, but your brother's abdomen has told a lie Secondly, if the disease was caused by the Jinn and (sadaqa Allah wa kadhiba Batn Akhika). Let him evils, therefore, the ordinary medical therapies were drink honey. So he made him drink honey and he was insufficient. Instead, it has to be cured by giving the cured." (4). effort that may help to end the evil spirit's influence From the above hadith, the treatment of disease i.e., by strengthening faith in God. This is because, if a was very simple. May be because the Prophet (s.a.w) persons' soul was fortified with strong faith, the evil knew what made the patient sick because he was spirits could not easily influence a Muslim. In other aware of the well-known method of treatment of diar- words, the spiritual disease is appeared as a result of rhea. In that time, diarrhea was treated by making the the lack of faith and misery of the soul. In this case, the patient vomit or by giving him laxative medicine to spiritual disease has to be cured by spiritual treatment. increase the flow by taking honey. In relation to this,
JISHIM 2004, 3 11 Nurdeen DEURASEH AHADITH OF THE PROPHET (S.A.W) ON HEALING IN THREE THINGS (AL-S HIFA' FI THALATHA): AN INTERPRETATIONAL* the hadith is concerned about a man who came to the by attributing cure to themselves and not Allah (s.w.t). Prophet (s.a.w) and said that his brother was suffer- Thus, if we relate this idea with the statement," the ing from dysentery (istatlaqa batn). To cure this dis- statement of God is true and the stomach of your ease, the Prophet (s.a.w) recommended honey. He brother lies," we may conclude that sometimes the came back and reported honey had done no good to measures that humans take to cure a disease may not his brother. The Prophet (s.a.w) was again advised to be sufficient on their own to alleviate and ease the take honey. He came back the third and also the condition; it is Allah's divine intervention and mercy fourth time and said he had seen no improvement. that brings about the complete cure (3). The Prophet (s.a.w) said: "The statement of God is Of course, there is no sharp different between the true and the stomach of your brother lies (sadaqa above view with the following. It is equally obvious Allah wa kadhiba Batn Akhika)." (4). that the commentators of hadith seem to agree that Apparently, the brother's patient claimed that he the hadith referred to a particular kinds of stomach had followed the instruction of Prophet (s.a.w), but it disease namely diarrhea. It is mostly occurred when was no consequences. Thus, we cannot conclude the mucus (a liquid produced in parts of body such as in discussion on this hadith without giving a few words nose) clings to the bowels and interferes with the about the meaning of the saying of Prophet (s.a.w): process of absorption. With this illness, it is honey "The statement of God is true and the stomach of your that expels the excess moisture. Because, the mois- brother lies (sadaqa Allah wa kadhiba Batn Akhika)." ture is driven out and expelled downwards when It is important to understand the hadith especially honey is eaten. In Umdah al-Qari, Ibn Ahmad al- the Prophet's statement, "The statement of God is true Ayni expressed and recognized that drinking honey and the stomach of your brother lies." Before we give may open up the obstructions of the blood vessels, the correct interpretation of this statement, there are dissolve the excessive food by evacuating the stom- two major remarks, which derive from the hadith, ach and intestines and clear the chest and liver (3). that we have to put into consideration. First, the Furthermore, al-Baghdadi was of the opinion that Prophet (s.a.w) was aware of the disease and the cure honey, which contains a variety of sugar and mineral, that was suitable for the patient since he was surely is good to purify what in the veins and stomach. belief of the benefit of honey for patient. It is the Consequently, it is a potential to make the blood to nature of honey to expel whatever is left of whatever circulate better and provide more air to areas of the has collected in the stomach and the intestines. body such as the brain (2). Secondly, the Prophet (s.a.w) instructed the patient to It is clear from the above discussion that we can- take honey for many times to make sure it may cure not understand the Prophet's prescription of honey as positively the disease. The patient should not lose the way for treatment of disease unless we know patience for his suffering of illness because, some- what disease he was fighting. It is necessary to define time, certain diseases take many years to cure and in what type of diarrhea of patient before giving honey. natural way can take at least months (3). In relation to this, al-Kahhal b. Tarkhan, an earlier Now, after giving remarks on the above hadith, it author of the medicine of Prophet (al-tibb al- is worth to give the view of commentators in regard to nabawi), had written that Prophet (s.a.w) was well the saying of Prophet: "The statement of God is true aware that diarrhea was caused by indigestion and the stomach of your brother lies." Some of them, (tukhma) resulting from overeating. Thus, he gave i.e., Ibn Mas`ud, Ibn Abbas, al-Hasan and al-Qadi the correct treatment by asking the patient to drink `Ayyad, viewed that honey is not only the factor of honey. The reason why the Prophet had said the healing because all are connected with God who is a patient's stomach lied was that he knew that the Healer (huwa al-shafi). This mean that, in any med- dosage had not been sufficient, because it had not ical treatments, doctors are only attempting to cure, it staunched the diarrhea and the Prophet (s.a.w) want- is Allah who cures, Allah huwa al shafi. This interpre- ed to stress that honey was the correct cure but in this tation is a reminder that men should not be arrogant case it had to administer several times (5).
12 JISHIM 2004, 3 AHADITH OF THE PROPHET (S.A.W) ON HEALING IN THREE THINGS Nurdeen DEURASEH (AL-S HIFA' FI THALATHA): AN INTERPRETATIONAL* While it seems quite certain that honey is the most As we expected, many ahadith would be recorded suitable prescription for the patient, as mentioned in in Kitab al-Tibb of Sahih Bukhari. They were record- the hadith, now, if someone are facing similar prob- ed from chapter eleven to chapter fifteen of kitab al- lem, can honey be used effectively? This needs the tibb. One of these five chapters is Bab al-Hijamah min clarification and understanding the other part of al-Da' (cupping as a treatment for disease). In this hadith, "fihi shifa li al-Nas (in it (honey) is healing chapter, Imam Bukhari mentioned that Jabir bin for men)." This is because some people believe that 'Abdullah narrated that he visited al-Muqanna while he honey is beneficial for all kinds of diseases and for all was illness. Jabir said, "I will not leave till he gets people. To answer this claim, Ibn Hajr clarified that cupped, for I heard Allah's Apostle saying, "There is the statement, "fihi shifa li al-Nas", did not means healing in cupping." Secondly, Imam Bukhari report- that honey is suitable to use for all people because the ed that Allah's Apostle was cupped on the middle of his words "li al-Nas" designated that honey was only head at Lahy Jamal on his way to Mecca while he was suitable for "some people" and not for "all people". in a state of Ihram. Thirdly, Imam Bukhari reported This means that honey is possibly harmful for some that: "Allah's Apostle was cupped on his head. Lastly, people who live in hot region (2). In other words, al-Bukhari reported that the Prophet commanded the honey cannot be cured for all kinds of disease. cupping to be used and said: "There are no remedies comparable to cupping and blood letting." (6). B. Cupping (al-Hijamah) While interpreting the above ahadith, there are In a number of medical systems, from Greek to two general remarks that we may draw. First, there is Malay traditional medicine, illness believed to be no specific time to practice cupping because the caused by harmful and dirty blood must be treated by Prophet (s.a.w) was cupped at day and night and taken out the dirty blood. Under this influence, peo- sometime during Ihram. However, we have to keep in ple believed that wherever part of the body, from mind that if blood cupping is done in the wrong place head to toe, become ill, hijamah can be used as the and times or when it is not needed, then it weakens the right measure for treatment. Therefore, if we wish to faculties and it remove both healthy humors as well as know the history of treatment of disease in the light harmful ones. That is why medical doctors advise, for of al-Tibb al-Nabawi, we must study hijamah safety purpose, that cupping should be avoided by because it was widely practiced by the Prophet those who is suffering from enteritis, by whoever is on (s.a.w) and his companions and this method of heal- the road to recovery, by whoever is very old, weak ing is still alive in many Muslim countries. liver or stomach, who suffers from palsy of the face or We were told that the Prophet (s.a.w) and his com- feet and by women who are pregnant or who have just panions always had practiced al-hijamah in several given birth or who are menstruating. occasions from the time he was at home to the time Secondly, it seems quite certain that the Prophet that he was in the state of Ihram. It is very regrettable (s.a.w) was cupped on his head. That is why Imam that we do not have very clear rational explanation Bukhari entitled one of the chapters of his kitab al-tibb why cupping was so popular in the time of Prophet, as al-hijamah ala al-ra`s (cupping on the head). In but one fact is nevertheless clear that hijamah is very truth, the view that headache was caused by dirty blood easy to practice, just using a jar or a similar material. in the head was widely spread among the ancient peo- A jar is attached to the skin surface, so that the dirty ple, and sucking of harmful blood was therefore a chief blood, air, toxic and other harmful substance flow to method of treatment. We are not surprising to hear that the surface of the skin. Then, harmful substance may the Prophet (s.a.w) was cupped on his head to treat remove from the body. Secondly, it is because the headache and similarly when a man who complained to dwellers of the Arabian peninsular and countries of the Prophet (s.a.w) about a pain in the head, the Prophet hot climate are the most suitable people to be cupped. (s.a.w) recommended him to get cupped (2). This is because the blood of people who dwell in that region is thinner (raqiq) and is drawn closer to the With advance of method of treatment, people have surface of the skin (tamil ila zahir al-abdan) (2). observed that the use of leech, as a means of sucking
JISHIM 2004, 3 13 Nurdeen DEURASEH AHADITH OF THE PROPHET (S.A.W) ON HEALING IN THREE THINGS (AL-S HIFA' FI THALATHA): AN INTERPRETATIONAL* blood from the affected parts of human body, was sim- the surgery site. This is used to collect the electricity ilar to cupping (hijamah). In other words, the use of from the body and safely discharge it back to the leech and other modern methods of healing can be machine. A grounding pad is placed on the person's regarded as a substitute for cupping. In Graeco-Arab body (usually the thigh) before the surgery starts to medicine, leech-therapy occupied an important place. protect the patient. Of course, it causes a patient in Ibn Sina and al-Baghdadi, for example, wrote specific painful and menace compared to a gulp of honey and section to leech in their al-Qanun fi al-Tibb and al- cupping. In the time of Prophet, al-kayy or hot metal Mukhtarat fi al-Tibb respectively. According to Ibn was used as a way to burn a wound to stop the blood Sina, the application of leech is more useful than cup- or stop it becoming infected (2). The question now ping in letting off the blood from deeper parts of the arises, is forbidden (haram) to use al-kayy for medical body. Treatment by the use of leech is desirable in skin purpose? If not, why did the Prophet discourage his disease. For al-Baghdadi, the use of leech was the best Ummah to use cauterization even though he had way for skin disease, wet and chronic ulcers. Leech is known that it might give many medical benefits. also used for reducing the weight of fatty and fleshy While commenting the ahadith on al-kayy, some com- people. They can be used repeatedly, but one should be mentators of Sahih Bukhari like Ibn Hajr al-Asqalani, aware of the risk of cross-infections. Leech may also Ibn Ahmad al-Ayni and al-Qastalani had attempted to be used as a means of cleaning the tissues especially give the reasons behind the wisdom of the Prophet after micro-surgical operations. Since there is possibly (s.a.w)'s words "I forbid my followers to use (cauteri- risk over using leech, al-Baghdadi and other Muslim zation) branding with fire ('wa `anha `an ummati an physicians suggested that the leech was needed to be al-kayy')" as recorded in the following ahadith: The cleansed. The dirt or dust clinging to a leech should be Prophet (s.a.w) said, "If there is any healing in your wiped off before application. When leech has sucked medicines then it is a cupping operation, or branding out the blood and tend to drop down, salt should be (cauterization), but I do not like to be (cauterized) sprinkled on the affected part of the human body. The branded." (8). In another version, Imam Bukhari following is al-Baghdadi's words: reported that the Prophet (s.a.w) said, "Healing is in "When they are to be used, they should be kept three things: cupping, a gulp of honey or cauteriza- away for a day and then applied. If a leech tion, (branding with fire) but I forbid my followers to does not stick, fresh blood should be poured or use cauterization (branding with fire)." (1). thoroughly smashed and pounded clay sprin- Though some commentators of hadith understood kled over the affected part and if the affected that the Prophet (s.a.w) prohibited his followers to part is free of any wound, the part should be use cauterization, however, Ibn Hajr did not interpret rubbed till it becomes red" (7). the words "wa anha an ummati an kayy (I forbid my followers to use cauterization)" as prohibition (al- C. al-Kayy: Branding with Fire nahy) but abhorrent or undesirable (makruh). He (Cauterization) argued that it is undesirable to use cauterization if it may cause the pain and menace to a patient (2). It is Al-Kayy is another method of treatment of disease quite reasonable to accept this reason because by in the time of Prophet (s.a.w) and even after. In rela- nature cauterization (al-kayy) may cause the patient tion to this, it is worth to mention that the process of in pain, menace and produce the side effect. This is destroying tissue by heating or freezing it is known at the reason why the Prophet (s.a.w) did not like al- the present as electrocautery. It is done by using a kayy (cauterization) as the right method of healing. small tool which has an electric current running through it. So that it is able to cauterize or burn the tis- In order to give further evidence that cauterization sue. Normally, this method of treatment, electro- is not prohibited in Islam, Ibn Hajr quoted the hadith cautery, is a safe procedure and is routinely used in which was reported that the Prophet (s.a.w) had him- surgery to burn unwanted or harmful tissue. self cauterized the wound of Sa`d b. Mu`ad (2) and Sometime, a small electrode is applied to the skin near also the wound of As`ad b. Zararh in order to stop the
14 JISHIM 2004, 3 AHADITH OF THE PROPHET (S.A.W) ON HEALING IN THREE THINGS Nurdeen DEURASEH (AL-S HIFA' FI THALATHA): AN INTERPRETATIONAL* bleeding (anna al-nabiy (s.a.w) kawa As`ad b. Zararh Sharh Sahih al-Bukhari, did not hesitate to add that min syawkihi) (2). Also, Ibn Hajr mentioned that Ibn al-kayy was not as other ways of treatment as far as Umar (r.a) used to use cautery for treating facial palsy. side effect is concerned. In case of cauterization (al- This is according to the report of Abu Zubayr who kayy), it might give medical benefits and harmful as said: "I saw Ibn Umar one day, and he was branding in the case of al-khamr (intoxicating drink) which the forehead of a man who had a slight facial palsy." according to the Qur'an, it might give both beneficial From all these evidences, Ibn Hajr concluded that the and harmful for mankind, but harmful is more (2,9). prohibition against utilizing cautery applies for as long Al-Dhahabi took a similar attitude to the tradition as completed trust in Allah (s.w.t) is lacking. During concerning the prohibition of cauterization. He Prophet's time, there were people who they think that claimed that the cautery of bleeding wounds was per- it is the cauterization itself which cures the affliction. missible especially when it was knows to be the best In other words, they believed that if cautery had not possible cure for a particular illness but it was forbid- been used, then the patient would have perished. This den as a preventive measure. kind of cauterization practiced, according to Ibn Hajr, For those who said that cauterization is forbidden is prohibited. On the other hand, cautery is permitted in medical purpose are mainly based on the hadith when it is perceived as being the appropriate means to related by Ibn Abbas that the Prophet (s.a.w) said: "If affect a cure, but not the essential cause of the cure the cure ultimately depends on either scarification, or because Allah (s.w.t) alone cures and grants good drinking honey or cauterization with fire, then I health and not cauterization. This means that humans absolutely forbid cauterization." It is regrettable that try, but it is Allah who cures, Allah huwa al Shafi. this school of thought does not give further explana- Humans should not be arrogant by attributing cure to tion and justification of the hadith. themselves and not Allah (s.w.t). Of course, human cannot refuse to take measure to cure disease claiming From the above analysis, it would be a great mis- that Allah (s.w.t) will take care of it. This is because, it take to prohibit the cauterization today. If it is forbid- is true that Allah cures but in some cases that cure den in Islam, the surgery should be also forbidden. operates through the agency of humans. Sometimes Therefore, it is right to conclude that it is perfectly the measures that humans take to cure a disease may correct to recommend al-kayy (cauterization) as the not be sufficient on their own to alleviate the condi- method of treatment of disease when all other reme- tion. It is Allah's divine intervention and mercy that dies i.e., a gulp of honey and cupping have failed. In brings about the complete cure (2). other words, it is fully permitted when there is no other alternative or no other remedy has proved suc- Ibn Ahmad al-Ayni viewed the hadith, i.e., healing cessfully. In this case, there can be no objection to is in three things: cupping, a gulp of honey or cauteri- use cauterization so long as it is done cautiously and zation, (branding with fire) but I forbid my followers to we remain aware of its negative effects. use cauterization (branding with fire), as preference from one thing over another. This means that as long as Conclusion medicine conceived disease in terms of philosophy and The study of ahadith of the Prophet on healing in looked upon it as a disturbance in the equilibrium of three things is extremely interesting and is important body's humors, cauterization could not be more than a for various reasons. First, it throws light on the con- last resort to which physicians had to recourse when ditions of Muslims in the time of Prophet, how did the treatment by honey and cupping failed. In this case, they treat the disease, if somebody was sick. Another the Prophet (s.a.w) preferred honey, blood letting over reason is that the treatment of disease was mainly cauterization and it does not means that cauterization is based on the cause of disease. These remarks lead to prohibited (haram) in medical treatment (3). the conclusion that we should not use al-tibb al- Although al-Qastalani was aware that Ibn Hajr nabawi (medicine of the Prophet) without empirical and al-Ayni's interpretation of the hadith are harmo- research because of changes in medicinal plants and ny with the Islamic law, he, in his Irshad al-Sari li environment as well as the meaning of linguistic
JISHIM 2004, 3 15 Nurdeen DEURASEH AHADITH OF THE PROPHET (S.A.W) ON HEALING IN THREE THINGS (AL-S HIFA' FI THALATHA): AN INTERPRETATIONAL* terms. Thus the conditions for which these remedies Department of Government and Civilization Studies, were prescribed in the first century of hijrah may not Faculty of Human Ecology, University Putra Malaysia be exactly the same as the conditions we are dealing (UPM), 43400 UPM, Serdang, Selangor, Malaysia. with today. Therefore, if we wish to have a complete account of Prophetic medicine, we shall not be satis- REFERENCES fied by referring to the writing of traditionalist schol- ars in the past without referring to the new discover- 1. Sahih Bukhari. Kitab al-tibb. Bab Shifa' fi thalatha. ies made by the researchers after the demise of 2. Ibn Hajr al-`Asqalani. Fath al-Bari fi Sharh Sahih Bukhari. 13 vols. Beirut: Dar al- kutub al-`ilmiyyah, 1989, 10: 170- Prophet (s.a.w). 172, 186-188. 3. Badr al-Din `Ayni. Umdah al-Qari Sharh Sahih Bukhari, Acknowledgement 21: 231-232. This article was prepared while I was a Visiting 4. Sahih Bukhari. Kitab al-Tibb, Bab al-Dawa bi al-Asal waqawl Allah Ta`ala fihi Shifa li al-Nas. Fellow at the Oxford Center for Islamic Studies (OCIS). 5. Ibn al-Qayyim. al-Tibb al-Nabawi. I would like to express my deepest thank to the Director 6. Sahih Bukhari. Kitab al-tibb, Bab al-Hijamah min al-Da'. of OCIS, Dr. F.A Nizami for giving me the golden 7. Al-Baghdadi. Kitab al-Mukhtarat fi al-Tibb, 1: 299. opportunity to conduct my research at the Center as well 8. Sahih Bukhari. Kitab al-Tibb, Bab man iktawa aw kawa as for the funding that I received from the Center. ghyrihi wa fadl man lam yaktawi. Currently, the author is a senior lecturer at the 9. Al-Qastalain. Irshad al-Sari. 12: 413.
16 JISHIM 2004, 3 The School of Traditional Iranian Medicine The Definiton, Origin and Advantages
Moshen NASERI*, Mohammad Reza Shams ARDAKANI**
* MD, Ph.D, Assoc. Prof. Department of Pharmacology, Faculty of Medicine, Shahed University, Iran ** Pharm D. Ph.D, Assoc. Prof. Department of Pharmacogenosy, Faculty of Pharmacy, Tehran University of Medical Sciences, Iran e-mail: [email protected]
Summary Traditional Iranian Medicine (TIM) consists of the sum total of all the knowledge and practices used in diagnosis, prevention and elimination in Persia from ancient times to now, from generation to generation relying exclusively on practical experience and obser- vation handed down from generation to generation. TIM roots go back to over 2000 years ago and it is not too bold to go even fur- ther and claim that the Persians taught the Greeks the elements of that system of medicine, which has been known ever since as Greek medicine. Traditional medicine has special advantages with respect to all the imported medical systems; since it is considered as part of the people's culture; and has a significant role in solving some of the cultural issues of health. Simply, traditional medicine can be a good assistant and help to the scientific and universal medicine. Introduction, development, and promotion of traditional medicine are a respect and honor to the culture and heritage of the people all around the world. Key Words; Traditional Iranian Medicine, Iran, Persia.
The School of TIM Howard-Jones has written in the World Health TIM (1) is a school that views the world as a good Organization (WHO) magazine of 1972 "the most and seeking discipline created by the wise and omnis- important editor of medical books in Islam was Abu cient Almighty (2); and has named the physician a Ali Al Hosein Ibn Sina . His medical book is named Hakim due to his dominance and proficiency in dif- Ghanoon; and up to now never a book has been so ferent sciences, and adequate comprehension of the famous; and it has been taught for a period of 500 world. The school of TIM, which its roots go back to years in the European and Asian medical schools" over 2000 years ago; as quoted by Cyril Elgood, the (4). Gustav Lobonne (1841-1931 AD) has written in English medical historian "was more advanced than his book about Islam and Arab Civilization "up to 15th century, the European scientists did not consider that of Assyria. It is not too bold to go even further any quotation that was not quoted from the Arab and claim that the Persians taught the Greeks the ele- authors as documented. All the European colleges ments of that system of medicine, which has been and universities were in working order on these trans- known ever since as Greek medicine" (3). According lations and the circle of our knowledge were just the to Ibn Khaldoon, Among Persians, rational sciences Muslim sciences for five to six hundred years; and in had a high status. Such sciences had a vast scope some fields of science like medicine, we can say that since Persians' governments were majestic and long- it has remained up to the current period; since the lasting. Words have it that after Darius' murder by writings of Avicenna has remained in France up to Alexander and the occupation of Kelikiyeh, and the end of the last century and some comments have access to the countless Persian books and sciences, been written about it (5). In their book History of such sciences were passed to the Greeks (4). Medicine, Meyer Steinegg and Karl Sudhoff have The stars of Islamic and Iranian medicine as Ibn written "the effects of the Razi medicine in the Sina, Razi, Ali Ibn Abbas Raban Tabari, Majoosi European medicine was prevailing for consecutive Ahwazi, Ibn Abi al Sadegh Neishabouri, Seyed centuries. His great book Alhavi fetteb has been Ismail Jorjani held the leadership of medical schools translated into Latin and for a long period it was the in west and east at least for 5 centuries. Dr. Norman reference for the scholars of medical sciences" (6).
JISHIM 2004, 3 17 Moshen NASERI THE SCHOOL OF TRADITIONAL IRANIAN MEDICINE Mohammad Reza Shams ARDAKANI THE DEFINITON, ORIGIN AND ADVANTAGES TIM not only transmitted the medical sciences of development of traditional medicine in 1978. In this the ancient civilizations in a modern and compiled declaration the brief definition of traditional medi- manner to the next generations; rather, the scientists cine is as follows: "The sum total of all the knowl- of this school were the founders and pioneers of the edge and practices, whether explicable or not, used in observation method and scientific experiment. diagnosis, prevention and elimination of physical, Avicenna explained the importance of clinical trials mental or social imbalance and relying exclusively in addition to animal studies as proof of efficacy of on practical experience and observation handed down drug. Ex professor Nayyar Wasti, who was one of the from generation to generation, whether verbally or in leaders of Pakistan traditional medicine has written writing" (10). In 2002 AD, WHO has described tradi- about the importance of the role of Iran in the devel- tional medicine with more details as: "Traditional opment of traditional medicine in the world: medicine is a comprehensive term used to refer both "Therefore, traditional medicine is Middle East med- to TM systems such as traditional Chinese medicine, icine, specially Persian medicine; since a number of Indian Ayurveda and Arabic Unani medicine, and to the expert and famous professors in the field were various forms of indigenous medicine. Traditional from Iran; and the medicine has been developed and medicine therapies include medication therapies- if promoted more in Iran and has been expanded all they involve use of herbal medicines, animal parts over the world by these authors. In the semi-conti- and/or minerals- and non-medication therapies - if nent of Pakistan and India, the books of Razi, Ibn they are carried out primarily without the use of med- Sina, and Molla Nafiss are still being studied in the ication, as in the case of acupuncture, manual thera- medical courses; and day and night the names of pies and spiritual therapies-. In countries where the these proficient and competent Iranian physicians are dominant health care system is based on allopathic repeated; and thousands of thousands of patients are medicine, or where Traditional medicine has not been treated and cured by this method. Therefore, the gov- incorporated into the national health care system, ernment of Pakistan has approved some laws to pro- Traditional medicine is often termed complementary, mote and develop this technique" (7). Furthermore, alternative or non-conventional medicine" (9). Hakim Syed Zillur Raman has written about the role Considering the above definitions, we can divide of Iranian physicians and scientists in the develoment TIM in to two sections: of medical sciences in Indai: "A number of great Iranian physicians such as Abu Fateh Gillani, A- Written Traditional Medicine: Fathollah Shirazi, Jallaldin Ardestani, Einolmalek This section includes the books and papers of Shirazi, Ali Gillani, Bagher Tabrizi, Mohammad Iranian scientists. That sums up to thousands of vol- Hashem Shirazi, Seyed Mohammad Asfar, Hossein umes. This huge collection contains different books Esfehani who had resided in Indai, brought about the about anatomy, principle of medicine, description of progress of Islamic medicine in India" (8). disease, materia medica, pharmacopoeia, diagnosis, and treatment. Some of them are: "Ghanoon fe Teb "by Definition of Traditional Medicine Ibn Sina, "Sharhe Asbab va Allamat" by Nafiss Ibn Since 30 years ago, in order to implement the slo- Avaz Kermani, "Alhavi" by Mohammad Ebn Zakaria gan "Health for Everybody up to 2000 ", WHO has Razi, "Al Eghraz Al Tabibeh" by Seyed Ismael Jorjani considered the development of traditional medicine. in Persian, "Ketab al Maleki" by Ali Ahvazi, "Al The decision is based on 2 foundations; first, lack of Abnieh An Haghayegh Al Advieh" by Heravi in access of a great number of people to primary Persian, "Kholasseh Al Tajareb" by Baha al Doleh health/medical services, which in some countries Razi Tarashti, and "Ferdows Al Hakameh" by Ali Ibn covers up to 80 per cent of the population; and sec- Raban Tabari; and also professional papers about spe- ond, dissatisfaction from the treatments of modern cial subjects such as "Ressaleh Dar Nabz" by Ibn Sina medicine, specially in relation to chronic diseases in Persian and "Ressaleh Atfal" by Razi, and "Ressaleh and the side effects of chemical drugs (9). On this Afyoonieh" by Emadaldin Shirazi in Persian about basis, WHO published a declaration regarding the specialized issues for treatment of addiction to opium,
18 JISHIM 2004, 3 THE SCHOOL OF TRADITIONAL IRANIAN MEDICINE Moshen NASERI THE DEFINITON, ORIGIN AND ADVANTAGES Mohammad Reza Shams ARDAKANI and "Ressaleh Atashak" by Emadodin about syphilis. physicians' services. In the United Kingdom, annual This valuable heritage is a written treasure for the CAM expenditure is estimated at US$ 2300 million researchers in Iran and the world; and by the power of respectively (9). In Canada, it is estimated that a total God, the value and importance of it will be more and of US$ 2400 million was spent in 1997-1997 on more cleared for the humanity. CAM. The global market for traditional therapies stands at US $60 billion a year and is steadily grow- B- Verbal Traditional Medicine: ing (19). Includes the experiments and information that has In Iran, the general statistics regarding the range of been transmitted, heart to heart from a generation to application of traditional medicine and different another generation and contains different health and schools of supplementary medicine are not specified. treatment methods (11). Since Iran has a long histori- However, the studies that were conducted in Isfahan in cal background and civilization, different races, lan- 2000 indicate that during the last 5 years, about 62.5% guages, and climates, it is a country full of verbal med- of the individuals have applied the supplementary ical experiments, opinions, and views; specially medicine methods, at least once a year. Utilization of among the tribes and the residents of this country, that herbs, prayer-therapy, cupping, and acupuncture with due to geographic reasons were difficult to pass; uti- 76.6, 10.1, 9.5, and 5.5 percent, were considered more lization of these medical experiments and treatment than other methods, respectively. The sale of herbal methods were integrated part of the life of people and medicine in Iran was about 7 billion Rials in 1997, the adequate recognition of the untrue and transfer of which has raised to 37 billion Rials in 2000 (Fig. 1). the experiments to the next generation was vital and Since about 50 % of the visits made by the physicians essential. Compiling this part of TIM that nowadays is does not need any drugs, if we use other treatment considered by the people of the world as native botany methods, the consumption of chemical drugs will be (Ethnobotany), native pharmacology (Ehtnopharma- reduced and by exporting drugs we could place the cology), and native medicine (Ethnomedicine) has country in a beneficial path and by this means decrease special significance; and delay and hesitation in col- our dependence; since, there are newer chemical drugs lecting and documentation of them; results in loss of that are certainly becoming more expensive on a daily parts of this valuable experiments; experiments that basis while our country is the origin of traditional may contain the key for solution of some of the med- medicine and variety of herbs with lots of medical fea- ical intricate questions (12-14). tures, variety, and high quality are considered as our valuable capitals (17). Reasons for Restoration of TIM 2- Simple Access and Low Cost 1- Economic Role There is a good drug variety in TIM; and usually In many developed countries, certain CAM there are a number of medicine for each disease, as (Complementary Alternative Medicine) therapies are prophet Mohammad (S) says "God didn't put any dis- very popular. Various government and non-govern- ease, but put for it many drugs" and this originates in ment reports state that the percentage of the popula- the mercy of God, so that the servants would not be tion that has used CAM is 46% in Australia, 49% in in trouble to maintain a drug, which is a genuine need France and 70% in Canada. The budgets allocated for and God says at Quran "and gave you all of you need traditional and CAM are also considerable; so that In exactly" and if a drug is not found in a region and or Malaysia, an estimated US$ 500 million is spent the patient annoyed a medicine; he could get advan- annually on TM/CAM, compared to about US$ 300 tage of other available medicine with the least million on allopathic medicine. In the USA, total expenses; and also if the nature of the patient is used 1997 out-of-pocket CAM expenditure was estimated to a drug and the medicine is no more effective, it at US$ 2700 million, which was comparable to the would be possible to take advantage of other drugs projected 1997 out-of-pocket expenditure for all (18). Drugs, quite often are materials that are avail-
JISHIM 2004, 3 19 Moshen NASERI THE SCHOOL OF TRADITIONAL IRANIAN MEDICINE Mohammad Reza Shams ARDAKANI THE DEFINITON, ORIGIN AND ADVANTAGES able, including botanic, mineral, and animal sub- imported systems of medicine in any setting because, stances that are available in the surroundings of the as an integral part of the people's culture, it is partic- environment; and usually could be accessible with ularly effective in solving certain cultural health little expenditures and is not comparable with the problems. It can and does freely contribute to scien- excessive costs of chemical drugs. tific and universal medicine. It's recognition, promo- tion and development would secure for a people's 3- Reliance on Moral Aspects culture and heritage (10). The roots of TIM could be found in Darolhekmah B- Approach-unique and holistic: Traditional and Hozehelmyeh (House of the science and scien- medicine has a holistic approach, viewing man in his tists) and was considered as a means for earning a totality within a wide ecological spectrum, and of low living. A large number of scientists and thinkers, emphasizing the viewpoint that ill health or disease is were learning the beneficial science of medicine brought about by an imbalance, or disequilibrium, of along with studying different sciences to maintain man in his total ecological system and not only by the their own and other people's health; since according causative agent and pathogenic evolution. (10). to the Prophet Mohammad "The best of you are who C- Operational factor: There are some of the benefit more the people" and rendered their efforts in main reasons why traditional medicine needs to be its propagation to the seekers of science; and believed promoted and developed. Perhaps, from the opera- that its moral reward will be their provisions for the tional point of view, the most cogent reason for the road to the afterlife. radical development and promotion of traditional medicine is that it is one of the surest means to 4- Finding new Medicines and achieve total health care coverage of the world popu- Treatment Methods lation, using acceptable, safe and economically feasi- Utilization of traditional experiments increases ble methods, by year 2000. (10). the probability of finding of effective medicine mate- rials up to 40%; this range is about 1% in random researches. Medicines such as Canabinoides, REFERENCES Vincristine, Artemisinin, Opioids and Colchicine, 1. Mosaddegh M., Naghibi F. TIM, past and present, Pilocarpin, Cantharidin, Spinal-Z (22), or other treat- Traditional Medicine and Materia Medica. Volume 1. ment methods such as acupuncture, general anesthe- Tehran, Iran: TMRC, 2002: 2-20. sia, application of traction instrument in replacing the 2. Naseri, Mohsen, Nezam Ahsan, Tahgigh. Better System and dorsal vertebra of spinal columns, and using catheters Research. Razi monthly magazine, February 1991: 47-50. for charging and discharging material in to the vesi- 3. Elgood C. Iran Medical History and the Regions of Eastern ca, take out the fetus by the hydrocephalus that cre- Caliphate, translated by Baher F. Tehran: Amir Kabir ates dystochia? application of gold filament for fixing Publications, 1992: 19. the mobile tooth and using the dental prosthesis that 4. Defa Ali Abdollah. Luminaries of Physics in Islamic Civilization, p 10, quoted from Ibn Khaldoon, Darolfekr has been sculptured from the tooth of the cow are Publications, p 479. undeniable testimonies of this subject. 5. Kahsani M, Pakdaman SJ, Abolghassem. Comparison of Iran Old Medicine with the Modern Medicine. Tehran Reasons for the Promotion of University Publications, 1978: 8-11. Traditional Medicine 6. Najmabadi M. Introduction to the Translation of Stories and Narratives of Almarza Razi, Tehran University Publi- WHO believes (10) there are three points that cations, 1977: 14. have resulted in the development and promotion of 7. Nayyar W. Traditional Medicine, A collection of articles traditional medicine: about TIM, Cultural Studies and Research Organization's Publications, 1983:130. A- Intrinsic qualities: Traditional medicine is 8. Rahman SZ. The Role of Iranian Scholars in the Development already the people's own health care system and well of Islamic Medicine in India, The International Congress of accepted by them. It has certain advantages over History of Medicine in Islam and Iran, Tehran, Iran, 1992.
20 JISHIM 2004, 3 THE SCHOOL OF TRADITIONAL IRANIAN MEDICINE Moshen NASERI THE DEFINITON, ORIGIN AND ADVANTAGES Mohammad Reza Shams ARDAKANI 9. "WHO Traditional Medicine Strategy 2002-2005 " Geneva, 16. Official Pharmaceutical Statistics Year 1997-2000, Ministry 2002: 1-3, 43-47 of Health and Medical Education. 10. "The Promotion and Development of Traditional Medicine 17. Bahrami A. Traditional Medicine University will be - Report of WHO Meeting "WHO Report series, NO. 622, Estabished in Iran, Ghods Newspaper Dated July 10th 2002. Switzerland, 1978: 8-13, 36-9 18. Khorassani A, Kabir G. Mahmoodi Publications, 1388, 11. Sezik E, Tabata M. Traditional Medicine in Turkey I. Folk quoted the meaning from pp. 3. Medicine in Northeast Anatolia, Journal of Ethnopharma- 19. WHO Launches the First Global Strategy on Traditional cology, 1991; 35: 191-196. and Alternative Medicine, Press Release WHO/38/ 16 May 12. Folder S. Supplementary Medicine, Seasonal Magazine of 2002: 2. Yonesco Payam. 1967; 143: 16-19. 20. Katzung BG. Basic and Clinical Pharmacology. 8 edition 13. Goldlee F. Medicinal Plants, Another Man's Poison, BMJ, 2001: 1088-1089. 1992; 305: 1583-1585 21. Nasseri M. Clinical Pharmacology in TIM, Razi Monthly 14. Packer M, Brandt JD. Ophthalmology's Botanical Heritage. Magazine, 1995; 12: 6-12. Survey of Ophthalmology, 1992; 36(5): 357-65. 22. White House Commission on Complementary and Alterna- 15. Zamani A, Mehdizadeh M, Yekta Z. Review the Position of tive Medicine Policy, Final Report, Chapter 5, 2002: 69. Substituting Medicine in the Presentation of Medical serv- ices of Isfahan, 1980. Educational and Research Seasonal Magazine, Better Health, 2001, First Year, No. 1.
JISHIM 2004, 3 21 History of Genetics in Islam: About Colour, Stature and Camels*
Haitham IDRISS*
* Ph.D., DIC. PO Box 400 Greenford UB6 0WY, U.K. e-mail: [email protected]
Summary Human Genetics is a science that studies inheritance of traits, e.g. within human beings. It is useful for understanding what is called genetic basis of certain diseases, lineages and inherited traits within a population. It has also been used in matrimonial issues such as assertion of parenthood. I wondered how long Muslims (of this nation) have been aware of this science. During my research I identified two narrations for the Messenger of Allah, peace be upon him that speak of his knowledge of this science. These narra- tions comment about hair colour in camels, skin and eye colour as well as stature in humans. This article looks at the two Hadeeths in relation the modern science of molecular genetics. Key Words; History of genetics, Islamic medicine.
human being and that he talked about certain matters in detail and other matters in principle and left the door of valid interpretations open to learned Know my learned friend that Allah almighty Muslims. Thus, it was sufficient for him to mention knows everything and that Allah Subhanahu Wa certain matters in general terms. This is one reason- Ta^ala taught man what man knew not, Allah said in ing Imam Abul Hassan Al-Ash^ari used to defend his the Quraan: use of ^Alm Alkalaam (2). It is also noteworthy that learned Muslims understood the Hadeeth of the mes- senger of Allah, peace be upon him, in different ways or had different levels of understanding, commensu- Also know, that the Messenger of Allah rate with the saying of the messenger of Allah, peace Muhammad, peace be upon him, knew more than any be upon him:
This means: May Allah beautify he who heard from us a say- Muslims have a traditional and healthy interest in ing and conveyed it as he heard it, for how many a medicine and medical sciences. This has been man reports a Hadeeth to one who has better under- encouraged by Islamic teachings, for example the standing of it. Narrated by Bayhaqqy (3). Hadeeth of the Prophet:
22 JISHIM 2004, 3 HISTORY OF GENETICS IN ISLAM: ABOUT COLOUR, Haitham IDRISS STATURE AND CAMELS
This means: Whilst recently lecturing on Human Molecular Genetics in London, it occurred to me to look at the For every Illness Allah created, Allah also creat- awareness of genetics during the time of Prophet ed a cure Narrated by Bukharry (4). Muhammad, peace be upon him. Molecular genetics The interest in medicine was reportedly further is a science that addresses the mechanisms of passing asserted by renowned scholars of Islam, such as traits between generations. It is useful for under- Imam Muhammad bin Idriss Asshafi^i, Imam of the standing many diseases that are classified as heredi- Shafi^i school of Jurisprudence and Imam Ahmad tary as well as for helping establish lineages and ArRifa^i (d 578 Hijri), Imam of the Rifa^i Sufi disci- other matters. Advances in modern genetics was pos- pline. sible due to the discovery of cell divisions, chromo- somes, DNA, chromosomal recombination, linkage Imam Mohammad bin Idriss Shafi^i, said to be and other significant molecular genetics mechanisms the scholar of Quraish mentioned in a Hadeeth that and other biological phenomena. I wondered when was narrated about the Messenger of Allah, peace be were Muslims of the Umma of Muhammad, peace be upon him,: upon him, possibly became first aware of the science of genetics. During my research I came across two narrations of the messenger of Allah, peace be upon him that indicated to me his knowledge of this sci- ence. The two hadeeths mentioned certain traits meaning: (colour) in Arabian Camels and stature in humans. The scholar of Quraish fills the world with Allah (Subhanahu wa ta^ala) said in the Quraan: knowledge. Related by Imam Ahmad and others in different versions (5). Imam Asshafi^i was born in Gazza in 150 H and In this verse of the Quraan Allah, Subhanahu wa died and was buried in Cairo in 204 H. He was ta^ala, is telling us to look at how camels are born reported to have empasised the importance of med- and use that as an example to strengthen our belief in ical sciences, calling medicine, which is a communal His power. obligation, the most honoured second to the knowl- The first prophetic narration in Sahih ul Bukharry, edge of At-Tawheed and other similar obligatory was narrated by Abu Huraira, may Allah be pleased Islamic sciences. with them:
JISHIM 2004, 3 23 Haitham IDRISS HISTORY OF GENETICS IN ISLAM: ABOUT COLOUR, STATURE AND CAMELS Abu Huraira narrated (herein stated in meaning): lowers how to draw analogy between two different living beings. Here the colour of camels was used to A bedouin came to the Messenger of Allah, explain what geneticists call inheritance of skin Muhammad (peace upon him) and said: My wife has delivered a black child. The Prophet said to him: colour in man. Additionally, one may deduce that Have you camels? He replied: Yes. The Prophet traits which off-springs show, such as skin colour, said, What colour are they? He replied: They are may not necessarily be the same as their immediate red. The Prophet further asked: Are any of them parents, but may be carried, in what scientists call, gray in colour? He replied, Yes . The Prophet the parents genetic composition (DNA) that may asked him: Whence did that grayness come? He manifest in later generations. This concept in modern said, I think it descended from the camels ances- genetics refers to genotypes, phenotypes, dominant tors. Then the Prophet said (to him): Therefore, this and recessive traits, whereby parents may have a child of yours has most probably inherited the colour genotype expressed, but not necessarily, as a certain from his ancestors Narrated by Bukharry (7). phenotype in off-springs. Parents may therefore act as carriers for traits that does not morphologically This hadeeth narrates the story of a man who was express in their siblings. A geneticist may interpret puzzled that his wife delivered a black child, whence the hadeeth of the messenger of Allah, peace be upon apparently he was not black and he decided to seek him, that his companion was puzzled that a pheno- fatwa from the messenger of Allah about the parental typic trait (black colour) was different than his, but status of this child. Ibnu Hajar Al ^Asqalani said, was not aware that he may be carrying the genes for Imam Shafi^i said in Al-Umm (what means): the it. Therefore, he implicitly asked the prophet whether apparent saying of the Bedouin suggests that he the child was his. The messenger of Allah through a accused his wife but since his statement had a face series of analogies, using camels as a model, taught other than Qazef (accusing someone of his companion the black skin colour his child pos- fornication/adultery without valid proof). The mes- sessed may be inherited from his ancestors, even senger of Allah, peace be upon him, did not judge though the colour did not manifest in him (apparent- him with Qazef and did not carry upon him the penal- ly or his wife), just like his predominantly red herd of ty for Qazef (8). camels had a Grey one in them. In other words, as Prophet Muhammads response to this man was to geneticists say today the phenotype for black skin- ask him about one trait in his herd of camels, namely colour was inherited from parents carrying genes for colour. He asked him whether in his predominantly both black and non-black skin colour. Geneticists red herd of camels there were camels that had a dif- may think, when reading this hadeeth, about the con- ferent colour, to which the man responded affirma- cepts of inheritance, phenotype, genotype, recessive- tively. The messenger of Allah further quizzed the ness and dominance as pedigrees. The messenger of man as to where he thinks this varied colour came Allah, peace be upon him, showed us the guidelines from and this man attributed this varied colour from in this hadeeth and left generations of human beings the camels ancestors (carried in their genes, as is said to work out the details (and Allah knows best). in modern terms). The prophet of Allah then taught It was not until several centuries after the narra- this man to draw analogy between this observation in tion of the aforementioned hadeeth that a Czech camels and what he observed in the newly-born sib- Christian monk by the name of Mendel described for ling. This implied this child would be attributed to the Europeans inheritance of monohybrid and dihybrid man who came with the query, despite having a dif- traits in plants and alluded to the concept of reces- ferent skin colour than his. siveness and dominance of traits. Mendels work was There are many things that one may deduce from based on observations of seven traits in peas that this Hadeeth of the messenger of Allah. Apart from were crossed for a number of generations (Figure 1). the moral guidance and judicial content, we may He argued that traits were inheritable and may be learn the prophets methodology in teaching his fol- genotypically carried, but may not necessarily mani-
24 JISHIM 2004, 3 HISTORY OF GENETICS IN ISLAM: ABOUT COLOUR, Haitham IDRISS STATURE AND CAMELS fest phenotypically in the next generation. Others described in this database. Perhaps Mendels work later said this may be extended to inheritance in would have been more broadly applied during his humans, leading subsequently to the generation in time had he used camels as a model, although this our modern times of a database known as OMIM may have been difficult as camels are scarce in the (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db= European continent. OMIM
The above Hadeeth, narrated through the compan- their inheritance was that she would be his heir and he ion Ibn Juraij, may Allah be pleased with him, states would inherit of her property the share Allah had pre- that: An Ansari man came to Allahs Apostle and said, scribed for him. Ibn Shihab said that Sahl bin Sad O Allahs Apostle! If a man saw another man with his AsSaidi said that the Prophet said (in the above nar- wife, should he kill him, or what should he do? So ration), If that lady delivers a small red child like a Allah revealed concerning his affair what is mentioned lizard, then the lady has spoken the truth and the in the Holy Quraan about the affair of those involved man was a liar, but if she delivers a child with black in a case of Li^an. The Prophet said, Allah has given eyes and large buttocks, then her husband has spo- His verdict regarding you and your wife. So they car- ken the truth. Then she delivered it in the shape one ried out Li^an in the mosque while I was present there. would dislike (as it proved her guilty). Narrated by When they had finished, the man said, O Allahs Bukharry (9). Apostle! If I should now keep her with me as a wife then I have told a lie about her. Then he divorced her In the aforementioned Hadeeth there is clearly a thrice before Allahs Apostle ordered him, when they companion concerned that his wife may have cheat- had finished the Li^an process. So he divorced her in ed on him and that the child may not be his, which his front of the Prophet . Ibn Shihab added, After their wife denied. Having undergone the process of Li^an, case, it became a tradition that a couple involved in a whereby each party declare in public that they are case of Li^an should be separated by divorce. That telling the truth, the man decided to divorce his wife. lady was pregnant then, and later on her son was Subsequently, the messenger of Allah declared what called by his mothers name. The tradition concerning possible physical attributes (traits) the child may
JISHIM 2004, 3 25 Haitham IDRISS HISTORY OF GENETICS IN ISLAM: ABOUT COLOUR, STATURE AND CAMELS
Figure 1. A diagram showing the seven traits in peas studied by Mendel. have and advised us which of these would confirm cate the wife had conceived pregnancy through extra- the husbands or the wifes allegations. In genetical marital intercourse, which apparently proved to be terminology one may say, he mentioned certain phe- the case. notypes the child may have and advised which phe- This Hadeeth portrays the knowledge that mes- notype may be inherited from the husband and which senger of Allah had about hereditary which made him clearly may not. Therefore, red colour and small size able to deduce phenotypic possibilities that would would indicate inheritance from the husband. Yet a manifest in the child had he been conceived through child with black eyes and large buttocks would indi- a marital or extramarital affair, having seen the hus- band and presumably knew of the third party. Apart from the matrimonial judicial aspects of this hadeeth,
Figure 2. An illustrative diagram showing a karyotpe of chromo- somes from a human cell. The cell nucleus consists of 23 pairs of Figure 3. A diagram of a eukaryotic cell undergoing mitotic cell homologous chromosomes (one from each parent), giving a total division. The homologous chromosomes are stained dark blue of 46 chromosomes. The last pair of chromosomes is said to and are shown to clearly separate on the red stained microtubule define sex (XX in females and XY in males). spindle.
26 JISHIM 2004, 3 HISTORY OF GENETICS IN ISLAM: ABOUT COLOUR, Haitham IDRISS STATURE AND CAMELS melanin pigment carried over on chromosome. Expression of Pheomelanin produces red/yellowish melanin, whilst that of eumelanin produces darker melanin. This occurs through the induction of tyrosi- nase and TYRP pathways respectively (reviewed in 10). It is beyond the scope of this article to work out all the combinations of parental genes that would produce a gray camel from heterozygote red ances- tors or black child from heterozygote white ances- tors, alas to say that it is possible to compute the probabilities and frequencies of this occurring and from what I read of the two aforementioned hadeeths, the messenger of Allah, peace be upon him, stated that accurately and one of the morphologies he described did show in the newly born child. Probabilities for genetic transmission of a single trait (e.g. short stature) in a Mendelian fashion is depicted in the Punnet square shown in Figure 1 for illustrative purposes. In conclusion, the two hadeeths of the messenger of Allah (peace be upon him) stand as a reminder of the knowledge of Muhammad, peace be upon him, Figure 4. Punnet squares depicting possible simple monohybrid and that he was the most knowledgeable human inheritance of short stature genes. Staure genes are said to be being. located on the sex genes (Gene map locus Ypter-p11.2, Xpter- p22.32) and are described to be inherited psuedoautosomally. Short (s) is said to be normally dominant to Tall (S). REFERENCES 1. Al-Quraan Al Kareem, Surat Al-Qalaam scientific aspects can be understood from it. The 2. Al-Ash^ari., Abul-Hassan, Istihsan Al-Khwud Fi ^Alm Al- hadeeth to learned geneticists alludes to inheritance Kalaam, of traits, but this time relates to polyhybrid inheri- 3. Al-Bayhaqy, Mukhtasar Shu^ab Al-Iman,. tance (inheritance of more than one trait). Further one 4. Al-Bukharry, Shaih Bukharry, Book of Medicine. may deduce that certain traits may be inherited con- 5. Al-Jarahi, Isma^il comitantly, e.g. red colour and body size or eye colour and hip size. This in modern genetics is called linkage, whereby genes tend to be co-inherited due to their physical closeness on a chromosome (the genet- ical aspect of cells).
In our modern times, geneticists define the genet- 6. Al-Quraan Al Kareem, Surat Al Ghasheyah. ical material as made of DNA, which in humans is 7. Al-Bukharry , Sahih Bukharry, Book of Divorce. carried within 2 sets of 23 chromosomes (1 set from 8. Ibn Hajar Al ^Asqalani,, Fathul Bari, Sharh Sahih Al- each parent), and which is carried over to off-springs Bukharry. during meiotic cell division and fertlisation (Figures 9. Al-Bukharry, Sahih Bukharry, Book of Medicine. 2,3). Skin colour is due to the expression of the 10. Strum RA, Teasdale RD. Box NF, Gene 277. 2001: 49-62.
JISHIM 2004, 3 27 Albucasis and Extraction of Bladder Stone*
Abdul Nasser Kaadan, MD, PhD*
* Head of History of Medicine Department, Institute for the History of Arabic Science Aleppo University, Aleppo - Syria The Scretary General of ISHIM (www.ishim.net) e-mail : [email protected]
Summary In the sixtieth chapter of the thirtieth treatise of Al-Tasrif book, Albucasis wrote on stone extraction from the urinary bladder. Albucasis invented a new lithotomy scalpel with 2 sharp cutting edges and he made a drawing for it. The innovation in the technique of perineal cystolithotomy, introduced by Albucasis, was of considerable practical anatomical significance. The aim of this paper is to shed light on the contribution of Albucasis in the field of Bladder Stone extraction. Key Words; Albucasis, Al-Zahrawi, History of Medicine, Bladder stone.
Albucasis (Al-Zahrawi) is Abul-Kasem Khalaf material gain. He also cautioned against quacks who Ibn Abbas Alzahrawi, believed to have been born in claimed surgical skills they did not possess. the city of Al-Zahra, six miles northwest of Cordoba, In the section on pharmacology and therapeutics, sometime between 936 and 940. It was here that he he covers areas such as cardiac drugs, emetics, laxa- lived, studied, taught and practiced medicine and sur- tives, cosmetology, dietetics, materia medica, gery until shortly before his death in about 1013, two weights and measures and drug substitution. years after the sacking of Al-Zahra. Albucasis had a tremendous influence on surgery Little is known about Albucasis. He was first in the west. The French surgeon Guy de Chauliac in mentioned by the Andalusian scholar Abu his Great Surgery, completed in about 1363, quoted Muhammad bin Hazm (993-1064), who listed him At-Tasrif over 200 times. Albucasis was described by among the great physician- surgeons of Moorish Pietro Argallata (died 1423) as without doubt the Spain. The first known biography of Albucasis, how- chief of all surgeons. Jaques Delechamps (1513- ever, appeared in al-Humaydis Jadhwat al-Muqtabis, 1588), another French surgeon, made extensive use completed six decades after Albucasis death. of At-Tasrif book in his elaborate commentary, con- It is clear from Albucasis life history and from his firming the great prestige of Albucasis throughout the writings that he devoted his entire life and genius to Middle Ages and up to the Renaissance. the advancement of medicine as a whole and surgery The last, thirtieth, treatise of this book, which is in particular. He wrote a medical encyclopedia span- related to surgery, is the most famous and important. ning 30 treatises which included sections on surgery, This treatise was translated into Latin by Gerard of medicine, orthopedics, ophthalmology, pharmacolo- Cremona in the second half of the twelfth century. In gy, nutrition etc. This book is entitled At-Tasrif France there is a Hebraic translation with surgical Liman Ajiza Anil Taalif (The book of enabling him to instruments schemes. The first edition of Albucasis manage who cannot cope with the compilations) and book was published in Venice in 1497, then more than contained data that Albucasis had accumulated dur- twenty editions appeared in many different European ing a career that spanned almost 50 years of training, cities. In the fifteenth century a Turkish translation was teaching and practice. made by Sharaf al-Din ibn Ali al-Hajj Ilyas, and char- In At-Tasrif book Albucasis insisted on compli- acterized by it beautiful pictures. The first modern edi- ance with ethical norms and warned against dubious tion with a Latin translation appeared at Oxford in 1778 practices adopted by some physicians for purposes of by John Channing. While French translation appeared
28 JISHIM 2004, 3 ALBUCASIS AND EXTRATION OF BLADDER STONE Abdul Nasser KAADAN in Paris in 1861. Arabic edition was published in 1908 modern method using the suprapubic, instead of the in Lucknow. English translation was accomplished in perineal, approach for the removal of bladder stones. 1973 by Spink and Lewis from welcome institute for Albucasis continues: history of medicine in London. Lastly Russian transla- tion performed by Zea Uddin Bavlove. I would like first to mention that this type of stone occurs mostly in boys. Among its symptoms is that the In the sixtieth chapter of the last treatise of Al- urine passes out of the bladder similar to water in its Tasrif book, Albucasis wrote on stone extraction thin consistency with the appearance of gravel in it. from the urinary bladder. He said: The patient often keeps scratching and playing with his I have already mentioned, in the Classification penis that often dangles down then becomes erect and the types of stones, their medical treatment, the differ- the rectum may prolapsed in many of them. The cure of ence between the stone borne [formed] in the kidney bladder stone is easy in boys up to the age of fourteen, and the stone borne in the bladder together with signs difficult in the elderly and midway in-between in young of all of them. I also pointed out that the need for oper- men. The treatment is easier in the patient whose stone ative intervention particularly arises in that stone is larger whilst with a small stone it is the opposite of formed in the bladder and that which gets impacted in that. When we start to undertake the treatment, the the urethra. Hereby, I will briefly, but clearly, describe patient, in the beginning, should have an enema to that technique. clear out all the stools from his bowel because it may prevent locating the stone during the search for it. Then the patient should be held by his legs and jarred to and fro and shaken downwards to bring the stone down to the bladder neck or, else, he could jump from a height several times. Then you seat him upright fac- Albucasis refers, here, to the second treatise of Al- ing you with his hands beneath his thighs to make the Tasrif book devoted to the classification of diseases as whole bladder tilted downwards. Then you search him well as their symptoms and treatment. This concern for [for the stone] by palpating him externally. If you feel establishing the correct diagnosis is a continuation and the stone in the lumen cut upon it right away. further development of the efforts of the famous physi- cian, Mohamed lbn Zakaria Alrazi (Rhazes) (841-926 AD) who was the first to give prime importance to clinical observations and differential diagnosis. Extraction of stones from the urinary bladder is considered one of the oldest surgical operations in history. The operation was done through a perineal incision down to, then through, the bladder neck to reach the stone and extract it. Comparing the descrip- This preoperative preparation of the patient by an tion of the operative technique as done during ancient enema was not known in the Ancient Greek or Indian civilization (Charaka in the first century and Roman medicine. It was Al-Razi who first described Susruta in the fifth century AD) and during the Greek it. In his book Al-Hawi (The Contienens) he says: Civilization in Aegean Sea Greece (Paulus Aegineta, Because stools in the rectum may render palpating 625-690 AD) with the description given by Albucasis for and locating of bladder stones difficult or impos- in this chapter, clearly shows how Albucasis remark- sible, it is essential that the patient should be given ably improved the technique of this operation and an enema beforehand. When the bowels empty out its reduced its risks. Albucasis modifications and inno- content the feeling for the stone, also the abdominal vations spread to Europe in Middle Ages and palpation becomes easier. remained widely adopted until the beginning of the It is to be noted here that most of the patients dur- 18th century which witnessed the beginnings of the ing that period were young children in whom the uri-
JISHIM 2004, 3 29 Abdul Nasser KAADAN ALBUCASIS AND EXTRATION OF BLADDER STONE nary bladder is usually easily palpable in the on the supra-pubic area. Keeping the bladder abdomen because of their small pelvic cavity. In squeezed will prevent the stone from dislodging those days, also, the stones were usually large in size. away from the surgeon left index finger already situ- ated in the rectum trapping the stone unto the bladder Albucasis says: neck. The recruitment of an assistant to perform that But if the stone does not come at all under your step leaves the right hand of the surgeon free to per- [finger] touch, then lubricate, with oil, the left index, if form the remaining steps of the operation. With the the patient is a child, or the middle finger if he is a fully left hand of the surgeon occupied in the per rectal fix- grown adolescent and insert it into his anus and search ation of the stone, a second assistant is also needed to out for the stone, until when it comes under your finger keep the testicles away and stretch the skin at the site you move it little by little to the bladder neck. Then you of the incision. press upon it with your finger pushing it outwards to This scalpel is an innovation invented by the place where you wish to make your incision. And Albucasis. It is different from the lithotomy scalpel in request an assistant to squeeze the bladder with his use during the Greco-Roman era. Albucasis invented hand and another assistant to extend away the testicles a new lithotomy scalpel with 2 sharp cutting edges with his right hand and use his other hand to stretch the and, being a novel instrument not known before him, skin beneath the testicles away from the place where he made a drawing for it. The scalpel called the incision will be made. Then you take the Al-Nashl Novacu1a used by the Italian surgeon Marianus scalpel whose picture is the following: Sanctus in the 16th century, and the scalpel used by the English surgeon Shelsden in the 18th century, were very close in shape to Albucasis scalpel. In the ancient and Greco-Roman texts before Albucasis, there is no such emphasis on avoiding the And incise in the area between the anus and the midline incision. That innovation in the technique of testicles not in the mid-line but to the side of the left perineal cystolithotomy, introduced by Albucasis, buttock.5 The cutting down is made directly on the was of considerable practical anatomical signifi- stone itself while your finger in the anus is pressing it cance. In Europe, during Renaissance, most of the outwards. The incision is made oblique, wide exter- well-known lithotomists such as the Italian nally but narrowing inwards to a size just enough to Marianus Sanctus (16th century AC), the French allow the exit of the stone, not larger, as your finger Jack De Beaulieu (17th century AC), and the in the anus may have already pressed on the stone English Shelsden (18th century AC), were using during making the incision thus leading to its extru- Albucasis lateral approach incising on the left side. sion without difficulty. Albucasis Says: You should know that some of the stones might have angles and edges that make their extraction dif- ficult. Some are smooth like acorns and rounded and, therefore, come out easily. In case of those with angles and edges, you need to slightly extend the inci- sion. If still the stone will not come out then you should maneuver it either by holding it with a strong forceps having a rasp-like [serrated] end to get a The choice of the finger to be used for rectal tight hold of the stone so it shall not slip out; or else examination is determined by the size of the anal ori- you introduce underneath it a slender instrument fice according to the age of the patient. This is with a curved end. If you, still, cannot manage the achieved by the assistants hand pressing downwards stone out, widen the incision a bit; and if some bleed-
30 JISHIM 2004, 3 ALBUCASIS AND EXTRATION OF BLADDER STONE Abdul Nasser KAADAN ing disturbs you, stop it with vitriol. If more than one the bladder, to enable its piecemeal extraction, as the stone is encountered, first push the largest to the foundation of the lithotripsy principle. They bladder neck, then you cut down upon it; then push described his instrument Al-Kalaleeb as a primitive the small stone next and continue doing the same if lithotrite. The technique attributed to Ammonius of they are more than two. But if the stone is very large, Alexandria (Second century BC) and described in it is utter ignorance to cut down upon, using a very Celsus book (50 BC) (introducing a scoop behind a large incision, because this will subject the patient to large stone and then a chisel-like instrument is driven one of two outcomes: either he may die or suffer from into the other side of the stone by the blow of ham- permanent incontinence because the wound site will mer in order to split the stone) is not well document- never heal. Rather you should try to manipulate the ed. The famous book of Paulus Aegineta (seventh stone out or, else, maneuver breaking it with the century AD), known to have summarized all previous Kalaleeb so that you can deliver it out piecemeal. Greek and Ancient medical and surgical knowledge, did not contain any mention of Ammonius or of any technique of splitting or breaking up a large stone in the bladder. On the contrary, it is documented that lithotomists, up to the 4th century AD, abhorred and warned against any attempt to fragment a stone inside the bladder before its extraction. It was Al-Razi who first doubted the belief, preva- lent among the ancients, that breaking of the stone inside the bladder during or before its removal endan- Albucasis was the first to use a forceps to extract a gers the patients life. In his book Al-Hawi, after cit- bladder stone. Before him, extraction of the stone was ing that Antylus, the Greek (2nd century) adhered to by an instrument similar to a small spoon that goes that belief, Al-Razi commented: This is to be looked around the stone and scoop it out. Accurate description into, God willing. However, Al-Razi, realizing of that new instrument and its use is given in the text. before Albucasis, the dangers of resorting to a large The use of Albucasis stone forceps spread to Europe incision to extract a very large bladder stone, during the Middle Ages and Renaissance. The drawing described a technique in which the sides of the stone of stone forceps shown in Marianus Sanctus book (the were made to protrude out through the small perineal middle of the 16th century) is exactly the same as the incision, then they were pinched off, one after the description and drawing of Albucasis forceps. other, with the Kalbatayn forceps which is similar to The details about how to deal with multiple blad- the Arrows Extracting forceps; that repeated breaking der stones were not mentioned in the works of the away of the stone sides outside the bladder was con- ancient or Greco-Roman scholars. Albucasis is the tinued until the stone became small enough to come first to describe a technique and an instrument to out without the need to fragment it inside the bladder. crush a large stone inside the bladder, thus, enabling That technique of Al-Razi was an important advance its piecemeal removal. That innovation by Albucasis in the evolution of bladder stone surgery which was was an important landmark in the development and soon followed by the breakthrough innovation of evolution of bladder stone surgery because it helped Albucasis mentioned before. to decrease the mortality and morbidity of the opera- The use of Albucasis lithotrite Al-Kalaleeb spread tion. He vividly warned that death or permanent to Europe during the Middle Ages and Renaissance; incontinence may result if a very large incision was its impact on European Surgery remained till the resorted to for extracting an intact very large stone. eighteenth century. The lithotrite introduced by He condemned that procedure and considered it utter Andreas a Cruce in the early eighteenth century was, ignorance. Both of Spink and Lewis and Kirkup con- in fact, a modification of Albucasis lithotrite in which sider Albucasis innovation of crushing a stone inside the manual compression on the handle was replaced
JISHIM 2004, 3 31 Abdul Nasser KAADAN ALBUCASIS AND EXTRATION OF BLADDER STONE by a screw action. However, instead of Albucasis for- The Arabic word used in the original text is kandar ceps, Andreas a Cruse used the scoop to extract the which is the solid gum of a tree with the same name. fragments. The metallic cylindrical canula was used The Arabic word used in the original text is Sabr: which to control bleeding by inserting it in the perineal is the juice of Sabbar tree. The Arabic word used in the wound at the end of the operation. original text is Shian (known also as Dammul Alakhwain). Hot swelling refers to the wound oedema Then in the 19th century more important modifi- due to reaction to the physical inflammation. The cation were successively added to Albucasis lithotrite Arabic word used for the verb spray is the verb Nattal when Amussat in 1822 managed to apply the princi- i.e. used the nattulat which are medicinal compounds ple transurethrally without the need to go through a locally applied by spraying or rinsing in jets or as perineal cystotomy. Eventually by 1832, Albucasis douches. Undue hot swelling refers to excessive oede- principle of a pair of jointed serrated blades to crush ma due to wound infection. The Arabic word used in (Al-Kalalib) was replaced by the modern principle of the original text is Aakelah which means cancrum. parallel non jointed blades, introduced first by Heurtloup and then rapidly developed to become the Albucasis says: mechanism used in the modern lithotrites. And if the stone is small and moved to the penile Albucasis says: passage and got impacted therein preventing the urine from coming out, deal with it in the way I am going to And when you finish operating, pack the wound describe before you resort to cutting upon, for often with frankincense, aloes and dragon blood then band- with this treatment, I managed without the need to cut age it tightly and cover it with layers of cloth soaked in on the stone. I did try [have experience in] this [proce- oil and syrup or in oil of roses and cold water to dure]1. You take a Mishaab [drill] made of Foulaz reduce the hot swelling. The patient, then, lies flat on [stainless steel] with a shape like this: his back and do not remove the bandage until the third day. When the bandage is removed, spray the area with plenty of water and oil; then treat it with palm oint- ment and basilicon ointment until it heals. If undue hot swelling and spreading gangrenous suppuration Its end is triangular and sharp and it is fixed to a develops in the wound or anything similar, like blood wooden handle. Then take a thread and tie it around clotting in the bladder causing retention of urine, the the penis below [ahead] of the stone so that it may sign of which is the passage of blood with urine, then not return back to the bladder. Then gently introduce introduce your finger in the wound and evacuate that the iron end of the Mishaab until it reaches the stone [clotted] blood; because if it remains inside it will lead itself and then, with your hand, revolve the Mishab, to dysfunction and sepsis of the bladder. Then wash the little by little, upon the stone itself aiming at making wound out with vinegar, water and salt and apply, for a hole in it until you perforate through to the other each development, the appropriate treatment for until side. Then, the urine will be immediately released. it heals. Also, it is essential, at all times during the Then with your hand on the outside of the penis, application of treatment to fasten the two thighs and squeeze what remains of the stone, it will crumble bind them together to keep in place the medications and be passed out with urine and the patient, Allah applied to the area. willing, will be cured.
32 JISHIM 2004, 3 ALBUCASIS AND EXTRATION OF BLADDER STONE Abdul Nasser KAADAN
This statement confirms the wide personal experi- corpus spongiosum at the same level. It was described ence and originality of Albucasis. It shows his ability to before by Paulus Aegineta in the 6th century invent new instruments and introduce, and test, new AD.However, Albucasis description of the technique is techniques. Accordingly, he was not a mere compiler different from that of Paulus who recommended but also a very skilled innovative surgeon. This proce- pulling tightly on the foreskin then fixing it that posi- dure was not described by any of the ancient or Greco tion by applying a ligature around it at the tip of the Roman scholars. It is therefore an original contribution glanz penis. Contrary to the Greco Roman scholars, by Albucasis. It laid the foundation for the principle of Albucasis was dealing with circumcised patients and lithotripsy; an important landmark in the evolution of this explains the difference in his technique from that urology. Albucasis procedure became widely recog- described by Paulus. This again shows the originality nized in Europe until the 19th century which witnessed and wide personal experience of Albucasis and con- a period of ingenuity on the part of surgeons and surgi- firms that he was not a mere compiler. cal instrument makers. Therefore, by the notion of get- ting at the stone while actually within the bladder, Conclusion Albucasis idea of drilling by Al-Mishaab which was Albucasis remarkably improved the technique of introduced in the bladder along a metal cannula was this operation and reduced its risks. His modifications the foundation of the litholepte of Fournier de and innovations spread to Europe in Middle Ages and Lempdes (1812), the instrument of Gruithusien (1813), remained widely adopted until the beginning of the Civiales trilabe (1818) and the brise coque of Rigal De 18th century which witnessed the beginnings of the Galliac (1829). Then the final modification to modern method using the suprapubic, instead of the Albucasis idea of drilling was in the replacement of al- perineal, approach for the removal of bladder stones. Mishaab with a rotating burr as in Leroy d Ettiole Albucasis invented a new lithotomy scalpel with 2 lithoprione (1822) and Civiales lithontripteur (1823). sharp cutting edges and, being a novel instrument not Albucasis says: known before him, he made a drawing for it. Albucasis is the first to describe a technique and an instrument to But if this treatment was not feasible for you crush a large stone inside the bladder, thus, enabling its because of an impeding obstacle, then tie a thread piecemeal removal. That innovation by Albucasis was below [ahead of] the stone and another above an important landmark in the development and evolu- [beyond]; then you cut down on the stone in the penis tion of bladder stone surgery because it helped to itself between the two ligatures and deliver the stone decrease the mortality and morbidity of the operation. out then undo the ligature and clear away the clotted blood that formed in the wound. It is a must to tie the thread below the stone so that it may not return to the REFERENCES bladder and the other ligature from above is needed so that when it is undone after removing the stone, 1. Al-Baba MZ. Some of medical books edited by Ibn Sina. Institute for History of Arabic Science-Aleppo University. the skin will return back to its place and, thus, covers Aleppo-Syria, 1984. the wound. It is for that reason that when you tie the 2. Albucasis. On Surgery and Instruments. English translation upper ligature you should pull the skin upwards so and commentary by Spink M S and Lewis G L, 1973. that, when you finish [the prcedure] it will recede 3. Al-Razi. Al-Hawi book, Haydar Abad, India, 1955-1976. back and covers the wound as we just mentioned. 4. El Afifi. S. Kasr El Aini. Journal of Surgery 1960. 5. Savage-Smith E. Islamic Culture and Medical Arts. Bethesda-Maryland: National Library of Medicine, 1994. 6. Ibn-Sina. Al-Qanun fit-Tibb. Vol. 3, Lebanon: Dar Sader, 1980:197. 7. Hamareh S K. The Genius of Arab Civilisation. In: Hayes JR eds. 2nd edition, Eurabia: Publishing Ltd, 1983. 8. Kaadan AN. The Surgery of al-Zahrawi, Dar al-Qalam al- This technique aims at decreasing the chance of Arabi, Aleppo-Syria, 1999, 357 pages. forming a fistula by avoiding incising the skin and the 9. http://www.muslimtents.com/historyofmedicine/zahrawi.htm
JISHIM 2004, 3 33 A Medical Ethics Perspective to Laws in Public Health in Turkey
Ayþegül DEMÝRHAN ERDEMÝR*
* Prof. Dr, Uludag University, Facultyof Medicine, Department of Medical Ethics, Bursa, Turkey e-mail : [email protected]
Summary Today, in Turkey, we see some laws on Public health. We can review them from the point of view of the medical ethics. These laws contain some articles. Ethical dilemmas on public health can be solved with their helps. For example, 52th and 112th articles of the Turkish Law of Protection of Health and with the number of 1593 is about immunization campaigns. These campaigns are com- pulsory for necessary persons. Here, public health doctor can explain this condition to identifying persons as emphatic. We know that one duty of all who conduct immunization campaigns is to ensure that everybody is aware of the risks. Moreover, other laws such as Turkish Law of Patients' Rights, Law of Socialization of Health Services, Turkish Agreement of Medical Ethics etc. Try to solve eth- ical problems on public health. In this paper, laws on public health in Turkey are pointed out from the point of view of the medical ethics and some results are obtained. Key Words; Medical Ethics, Public Health, Laws on Public Health.
We know that, ethics is the set of philosophical of 1593. In this law, we find many important articles. beliefs and practices concerned with distinctions According to the third article of this law, Ministry of between right and wrong; with values, human rights, Health should prevent the diseases of children, con- dignity and freedom; with duties to others and socie- duct immunization campaigns to prevent contagious ty. We all distinguish between what we regard as diseases. Ministry of Health applies these services acceptable (right) and unacceptable (wrong) with public health workers. These are public health conduct, although standards and criteria of right and doctors, nurses and officers. Today, in Turkey, the wrong vary greatly (1). developments in public health led public health doc- tor to suggest a necessary sequence for the control of Values are what we believe in, what we hold dear, any public health problem (3). what binds us to others of our kind; values are the foundation of morality. The law, which is based on The developments of public health are present in morality, tells us what we are allowed to do; ethics the faculties of medicine in many universities of tell us what we ought to do. The distinctions between Turkey. The specialists of public health who are ethics, morality and law are based on the intellectual trained in these departments can work in health dis- and emotional level at which we accept or abhor pensary. Moreover, practitioners can also serve as behaviour; whether we regard conduct as right or public health doctor in Turkey. Every doctor should wrong depends upon our ethics. Societal values are protect the health of persons. But, some ethical prob- the basis for many laws, whether enacted by legisla- lems on public health can be seen in Turkey. tion or based on decisions in a law court (2). In this article, we can explain them. Thus, accord- The developments in the science of public health ing to the 29-56. articles of this law, foreign persons caused the modernization of ethics of public health. with contagious disease are quarantined. General In Turkey, we see some laws on public health. One of Management of Turkish Coasts applies quarantine. them is very important. This is Law of Protection of We know identifying persons with communicable Health with the date of 1930 and with the number diseases means that they are labeled, and this can
34 JISHIM 2004, 3 A MEDICAL ETHICS PERSPECTIVE TO LAWS IN Ayþegül DEMÝRHAN ERDEMÝR PUBLIC HEALTH IN TURKEY stigmatize them. We know that the isolation and Responsible adults can choose, but for infants and quarantine restrict freedom. Individuals, families, small children, fluoridated drink water makes the dif- even entire communities may be identified and stig- ference between healthy and carious teeth. Applying matized, isolated, or quarantine and shunned by their the ethical principle of beneficence, public health neighbors. officials argue that infants and small children should Identifying and isolating cases is an accepted fea- receive fluoride to ensure that their dental enamel can ture of communicable disease control, held to be nec- resist cariogenic bacteria. essary to protect the population. The need to protect Proponents of computerized medical record stor- society has been recognized as a higher imperative age and retrieval systems assert that computerize than the rights of an individual patient or contact. records are more secure than paper records, but if When smallpox, cholera, polio, typhoid, diphtheria unauthorized access does occur, many peoples priva- and other contagious diseases were prevalent, few cy, not just one persons, can be violated. Moreover, people questioned the actions of public health author- computers can crash and a whole library of records ities who notified and isolated patients and quaran- may be lost or become inaccessible (4,5). tined contacts, often severely infringing the freedom and dignity of entire families. Applying the principle of beneficence, it is desir- able not only to maintain data files of health-related According to 52-102. articles of the Turkish Law information, but to expand them; available ideas as of Protection of Health, immunization campaigns well as available information should be used for the are compulsory for necessary persons. Here, public common good. Statistical analysis of health-related health doctor should explain this condition to identi- information has been so convincingly demonstrated fying persons as empathic. So, the beneficence of the to be in the public interest that there is no rational society is very important in Turkey. Moreover, one argument against continuing on our present course duty of all who conduct immunization campaigns is and further expanding the scope of these activities. to ensure that everybody is aware of the risks as well This argument applies with particular force to the use as having the benefits clearly explained to them; in of linked medical records, potentially the most pow- short, informed consent is essential. This is very erful method of studying diseases that are rare or important when children are not admitted to school have long incubation times, or both (6,7,8). without evidence of immunization; that is, when immunization is mandatory rather than voluntary. Health workers have an ethical duty to protect the confidentiality of the records that they use. Today, in Turkey, risk-benefit calculations are Irresponsible disclosure of confidential details that required for all forms of mass medication. The possi- can harm individuals is not only unethical but can bility of adverse effects or idiosyncratic reaction arouse public opinion against collection and use of always exists. Opposition to fluoridation of drinking such material. Properly used, health statistics and the water is based in part on the unfounded fear that flu- records from which they are derived do not invade oride can cause cancer or some other dread disease. individual privacy (9,10,11). According to the Epidemiologic analysis shows no association Turkish Law of Patients Rights with the date of between fluoridation and cancer. Opposition to fluor- 1998, the patient has the right of privacy (12). idation is more a political than a public health issue, in which the catch-phrase of the antifluoridation The process and procedures for obtaining movement, keep the water pure, is difficult to informed consent should be clearly understood by all rebut. Another political argument is that fluoridation health workers. The process consists of transfer of is a paternalistic measure, imposed on the population information and understanding of its significance to whether they like it or not. According to the ethical subjects of medical interventions, followed by principle of respect for autonomy, individuals in a explicit consent of the subjects (or responsible prox- free society should have the right to choose for them- ies) to take part in the intervention (13). According to selves whether they want to drink fluoridated water. the Turkish Law of Patients Rights, the informed
JISHIM 2004, 3 35 Ayþegül DEMÝRHAN ERDEMÝR A MEDICAL ETHICS PERSPECTIVE TO LAWS IN PUBLIC HEALTH IN TURKEY consent of persons is necessary in many areas of pub- members of family planning clinics have an ethical lic health. duty to offer advice and treatment, and an equally important duty not to enforce their own or official Health promotion is the process of enabling peo- views on individual clients in Turkey. ple to increase control over and improve their health. Health advocates regard it as a step toward Public health is inherently concerned with social autonomous decision-making for people who were justice, with fair and equitable distribution of formerly passive recipients of public health measures resources to protect, preserve and restore health. like purifying drinking water, mass vaccination pro- Public health workers therefore frequently become grams, dietary additives, tuberculin tests, and other advocates for health care systems that provide access routine public health interventions (14). to needed services without economic or other barri- ers. The principles of equity and justice go further. What could be more beneficent than spreading The allocation of health care budgets is often based information about risks to health and actions that can on political or emotional grounds and on the ability be taken to reduce these risks? Health education of eloquent spokespersons for high-technology diag- encourages all to take greater responsibility for their nostic and therapeutic services to promote these own health (15). Economic interests in communities interests. Funds sometimes are allocated for expen- dependent on the alcohol and tobacco industries, it is sive equipment and devices, while much - needed argued, also must be considered when deciding how public health services such as water purification to deal with public health problems associated with plans is need of renovation or logistic support for tobacco and alcohol use and abuse. These are com- immunization programs, go without funds. It is an plex economic, political and ethical questions. The ethical imperative for public health workers to be as ethical principles here are beneficence and justice aggressive as circumstances require in obtaining an (16). According to the Turkish Law of the Control equitable share of resources and funds for public of Narcotic Matters with the date of 1928, the pre- health services (19-21). Law of Socialization of vention of tobacco and alcohol use and abuse is nec- Health Services with the date of 1961 provides that essary. Here, beneficence of community is very every citizen make use of social services equally. important from the point of the medical ethics. Justice principle is provided with this law. Health dis- National population policies range from encour- pensaries provide health service for everybody. agement of couples to have or refrain from having Beneficence is the dominant ethical principle of children (often with related laws on access to and use public health in Turkey. The aim of public health of contraceptives) to vaguely visualized policies services ought to be to enlighten people about risks to implied by the appearance in newspapers and health and to assist people in gaining greater control womens magazines of articles on birth control that over environmental, social and other conditions that contain statements about the efficacy of contracep- influence their own health. We have an ethical duty to tive methods (17). According to the Turkish Law of work with people, empowering them, doing whatev- Family Planning with the date of 1983, curettage er may be necessary to promote better health-doing can be applied up to the 10th week with the desire of things with, not to, people (22). However, it is benef- woman. Birth control drugs and apparatus can be icent for public health workers to strive for econom- used with the prescription of physician. ic, environmental, social and political conditions that In a free society, public health workers have an will maximize good health. ethical duty to consider each patient or client as an Reactions to human immunodeficiency virus individual with her own unique life situation, prob- (HIV) disease have been different. It is important to lems, and requests - not as a case to whom the offi- protect the privacy of HIV-positive persons and to cial policies necessarily apply. The aspirations of safeguard the confidentiality of their medical records women and couples to have or refrain from having to minimize the risk of disclosing information that children are powerful and very personal (18). Staff could harm them or members of their families.
36 JISHIM 2004, 3 A MEDICAL ETHICS PERSPECTIVE TO LAWS IN Ayþegül DEMÝRHAN ERDEMÝR PUBLIC HEALTH IN TURKEY Health workers have an ethical duty not to discrimi- 3. Koroglu E. Saðlýk Mevzuatý (Health Law). Ankara: nate against persons infected with HIV. In Turkey, Yargýcoglu Press, 1994: 9-643. AIDS cases are few. In these kinds of cases, doctor 4. Clough JD., Rowan DW., Nickelson DE. Keeping Our Patients Secrets. Cleveland Clinic Journal of Medicine should respect to privacy principle and should inform 1999; 66(9): 554-558. this case to necessary administration places accord- 5. Fisher F. (BMAs Ethics, Science and Information ing to the Turkish Agreement of Medical Ethics, Division), Medical Ethics, Today. London, 1996: 24-66. with the date of 1960. Here, the beneficence of com- 6. Mariner W. Patients Rights after Health Care Reform. Who munity is necessary. Decides What is Medical Necessary? Am. Journal Public Health 1994; 8(9):1515-1520. Moreover, health insurance shows modern char- 7. Lain C., Davidoff F. Patient-Centered Medicine. JAMA acteristics in Turkey. But, we see some ethical prob- 1996; 275(2):153-156. lems in health insurance from the point of view of the 8. Richards PE., Rathburn CK. Public Health Law. In: Wallace medical ethics. Modern insurance laws are present, RB ed. Public Health & Preventive Medicine. USA, 1998: 1147-1154. today. We know two kinds of health insurances in 9. Ersan G. Türkiyede Sosyal Güvenlik (Social Security in Turkey. One of them is the health insurance with Turkey). Istanbul: Türk Dünyasý Arastýrmalarý Vakfý regard to the Official Foundations. Another one is the Publication No: 30, 1987. special health insurance. Ethical dilemmas between 10. Hortsman K. Technology and the Management of Trust in patient, insurance company and hospital can cause to Insurance Medicine. Theoretical Medicine and Bioethics some difficulties in the patients therapies. For exam- 2000; 21(1): 39-61. 11. Basagaoglu I., Demirhan Erdemir A. Health Insurance in ple, the hospitals of social insurances are very crowd- Turkey and Ethical Dilemmas. Bremen: Edition Temmen, ed in Turkey. The physicians cannot have the time for 2004: 68-115. the therapies of the patients. Sometimes, physicians 12. Hasta Haklarý Yönetmeliði (Patients Rights Regulation). cannot behave as emphatic because of their econom- Official Gazette 23420 numbered and 1 August 1998 dated. ical, social and professional problems. Some modern p. 67. laws try to prevent these problems (9,10). 13. Aydýn E. Türkiyede Saðlýk Sigortasý Giriþimleri (Health Insurance in Turkey). Bilim ve Ütopya 1998 Oct.; 58-60. There are laws or regulations aimed at protecting 14. Demirhan EA., Elcioglu O. Týp Etiði Iþýðýnda Hasta ve people against tainted foodstuffs, unsafe working Hekim Haklarý (The Rights of the Patient - Physician). conditions, and unsatisfactory housing. Moreover, in Ankara: Turkiye Klinikleri Publication, 2000:23-109. 15. New Challenges for Public Health. Report of an Interregional Turkey, community values and standards have lately Meeting, World Health Organization. Genova, 1996. shifted toward greater control over environmental 16. Medical Ethics, Today. British Medical Association. 1996: hazards to health, reflecting growing concern about 1-10. our deteriorating environment. Turkish Law of 17. Harris J. Wonderwoman and Superman. Oxford, 1992:1-110. Protection of Health has some articles on this topic. 18. Bird J., Cohen-Cole S. The Three Function Model of the Medical Interview, Methods in Teaching Consultation-Liaison In this paper, all of these topics are stressed from Psychiatry. Adv. Psychosomatic Med. 1990; 20:65-88. the point of the medical ethics and laws in public 19. Johnstone MS. Professional Ethics and Patient Rights: Past health in Turkey and some results are obtained. Realities, Future Imperatives. Nursing Forum 1989; 24( 3- 4):29-34. 20. Begley A., Blackwood B. Truth-Telling versus Hope: A REFERENCES Dilemma in Practice. Int J Nurs. Pract 2000; 6(1): 26-31. 1. Beauchamp TL., Childress JF. Principles of Biomedical 21. Demirhan EA. Lectures on Medical History and Medical Ethics. New York: Oxford University Press, 1994:.438-439. Ethics. Istanbul: Nobel, 1995: 113-118. 2. Harris J. The Value of Life. London and New York: 22. Emanuel EJ., Emanuel LL. Four Models of the Physician- Routledge, 1997: 4869. Patient Relationship. JAMA 1992; 267(16): 2221-2226.
JISHIM 2004, 3 37 Islamic Medical Ethics in Assisted Conception*
Farouk MAHMOUD*
* FRCOG, FRANZCOG, FRCS (E), Consultant Obstetrician, Gynaecologist and IVF Specialist, University Hospital, Coventry & Warwck., U.K. e-mail: [email protected]
Summary
A brief history of Islam and Islamic jurisprudence (Fiqh) is outlined with an overview of the evolution of Islamic medicine. Islamic medical care is conceptualized within the framework of Islamic medicine and Islamic medical ethics; medicines, techniques and technologies of assisted conception are scrutinised for compatibility with the guidelines of the Sharia. This article is mainly cen- tred on assisted conception, and the areas where these methods pose problems and conflict with Islamic thought and the Sharia, are discussed with an emphasis on how Muslims could derive benefit from modern technologies and yet not contravene the principles of Islam. The article concludes with glimpses into the future and examines the Islamic viewpoint on technologies, mainly reproductive techniques, in the horizon but yet to enter the realm of medical practice such as therapeutic cloning, gene therapy and stem cell tech- nologies. Key Words; Islamic Medical Care, Islamic Medicine, Islamic Medical Ethics, Reproductive Medicine, Assisted Conception.
Introduction tic preference), Istislah (public or community bene- Islam, the empire of religion, spread its faith fit) and Urf (custom), where the Quran and Hadith across the globe and bequeathed to the world, a rich do not provide a solution. At present, controversial intellectual heritage, fashioned, sculpted and imbued issues related to reproductive medicine are referred to Islamic jurists, Fuqaha and Muftis for a fatwa and with an Islamic mould, from the origins of Greek, more recently these issues are addressed by Fiqh Persian and Indian heritage. academies composed of Islamic scholars, doctors, Islamic medicine being eclectic, chooses the best lawyers, scientists and other persons with expertise in of available medical technology, compatible with the different fields. spirit of the Sharia and the Islamic community. To appreciate Islamic medical ethics in reproduc- Medical ethics in Islam may be defined as the prac- tive medicine, one has to be cognisant with the back- tice of medicine keeping within the ethos of Islam, ground of Islam and the evolution of Islamic jurispru- satisfying both, the criteria of autonomy, benefi- dence and these have been described, albeit briefly, cence, non-maleficence and justice and the principles followed by the methods of assisted of conception and precepts of Islam. with an integrated synthesis with Islamic values. Assisted methods of conception do provide solace and hope for the barren couples but they also pose Islam - A Historic Background special problems from a religious perspective. Islam Islam, the youngest of the religions of the transcends ethnic, religious and cultural barriers and Abrahamic faiths, was promulgated by Prophet all Muslims by their definition, submit to Allahs will Muhammad (saws) in 610 C.E., who preached the and therefore to the Quran and the Sunna of the new religion in the Arabian peninsula. The subse- Prophet. Their actions are governed by the Sharia and quent blossoming and expansion of Islam has been this applies equally to methods of assisted conception hailed as unprecedented and unparalled. In the wake they would choose. The Quran is immutable and so of these new conquests, came power, wealth and are the authentic religious Sunna but Islamic jurists affluence and while the rulers basked in the extrava- (Mujtahidun) are empowered to resort to Ijma (con- gance and splendour of the new empire and promot- sensus), Qiyas (analogical reasoning), Istihsan (juris- ed aesthetically beautiful architecture, there emerged
38 JISHIM 2004, 3 ISLAMIC MEDICAL ETHICS IN ASSISTED CONCEPTION Farouk MAHMOUD alongside, a thirst for knowledge. Both the Quran (Syria) were the major centres in the early years. Out and the Sunna of the Prophet espoused the acquiring of many, four schools of Islamic thought survived. of knowledge. The Kufians under Imam Haniffa preferred to use There was therefore, enthusiasm among the ruling their personal opinion (ahl al-ray) while the hierarchy to contribute towards this noble project. Medinites under Imam Malik tended to adhere close- Caliphs, Grand Viziers and others all vying for a ly to the Sunna (ahl al-Sunna); the former evolving place, showering their wealth towards furthering edu- into the Hanafi and the latter the Maliki school (mad- cation. An important subsidiary source of wealth was hab) of Islamic jurisprudence. Imam Shafi, was suc- the waqf, a trust fund bequeathed for charitable pur- cessful in synthesising and systematising the law and poses, be it a mosque, learning institution, hospice, was acclaimed as the architect of Islamic jurispru- Sufi lodge or for the needy. This new zeal and clam- dence and the Shafie school was named after him our and sponsorship of knowledge reached its zenith while the fourth madhab was named after Imam at the time of Caliph Mamun (son of Harun al- Hanbal. Islamic scholars and jurists continued to th Rashid), who was notable for inaugurating the Bayt flourish but since the early 13 century, the gates of ul hikma (house of wisdom). Following on his ijtihad was closed and the scholars were denied the fathers and predecessors footsteps, he encouraged privilege of conducting Ijtihad. Their intellectual and sponsored the acquisition of knowledge from contributions, shackled and fettered, they were Greek, Persian, Indian and Chinese sources. A large restricted to providing commentaries and supra-com- contingent of scholars, engineers, philosophers, doc- mentaries on the work of their predecessors. tors and other scientists from the Academy in However, since the 19/20th centuries, Ijtihad has Jundishapur (near present-day Isfahan in Iran), main- re-emerged as the vehicle of expression by jurists and ly Nestorian Christians, who fled from Edessa and provide rulings (akham) on matters not explicitly or Antioch to escape the persecution of Emperor clearly stated in the Quran or Sunnah. The Jurists Justinian, were enticed and wooed to migrate to (Mujtahids) accomplish their task reaching an agree- Baghdad. Institutions of higher learning, libraries, ment (consensus or ijma) on issues not clearly medical schools, hospitals were built, almost with a defined by the primary sources by extracting legal frenzy, in all Islamic lands, in Baghdad, Damascus precepts from the Quran or Sunnah or by resorting and later in Egypt and Andalusia, Samarkand, to Qiyas, Istihsan, Istislah or Urf. Moghul India and the Ottoman states. In Islam, all actions are categorised into obligato- ry, recommended, permitted, disapproved and forbid- Evolution of Islamic Jurisprudence den. In Islam, under special circumstances, even the This article deals with Sunni Islam and does not forbidden may be permissible. include the Shias, who differ in some respects from mainstream Islam. Sunni Muslims form one-fifth of Evolution of Islamic Medicine the population, totalling almost a billion people. Medicine had always taken pride of place, Islamic law or Sharia is mainly derived from the espoused both in the Quran and by the Prophet, but Quran (containing the divine revelations) and also the blossoming period of Islamic medicine was in the ahadith, a narrative of the Prophets sayings (Sunna era of the Abbassids, particularly Caliph Harun al al-Qawliyaa), acts (al-Sunna al-Filiyaa) and express Rashid and his son, Mamun. The doctors from or tacit approval (al-Sunna al-Taqririyya) referred to Jundishapur who formed the core of the medical pro- as the Sunna and constitute the primary sources. Ijma fession, complemented by the local Muslim, Persian (consensus) of Islamic jurists, analogical reasoning and Indian physicians, were responsible for the inau- (Qiyas), Istihsan (juristic preference), istislah (public guration of the most extra-ordinary advances in med- interest or community welfare) and customs (urf) icine and hospital architecture. The next few cen- form the secondary sources of the Sharia. turies produced some of the finest physicians, trans- Kufa (Iraq), Medina (Hijaz) and Damascus lation of medical literature from Greek, Persian and
JISHIM 2004, 3 39 Farouk MAHMOUD ISLAMIC MEDICAL ETHICS IN ASSISTED CONCEPTION
Indian sources into Arabic, directly or via Syriac and tantly, the number of embryos transferred to a maxi- the organisation and establishment of both civil and mum of two. army hospitals, mobile clinics and caravans, prison medical services, hospices, medical schools. The Sperm Donation Muslims adopted an eclectic approach, choosing the Donation of sperms and sperm banks have been in best and what was appropriate and compatible for existence for a long time and creates an ethico-reli- Islam and ignoring the rest. Thus evolved Islamic gious problem, in that it brings in a third party into medicine, a brand of medicine which was totally the process of conception who contributes half the acceptable to Islam and conforming to Islamic ethics. genetic make-up. Fortunately, artificial insemination with donor sperm has been relegated to the back- Assisted Conception ground since the advent of intra cellular sperm injec- An analysis of the assisted methods of conception in tion (ICSI) in 1992., the sperms could be aspirated or practice today, shows that artificial insemination and extracted from the epididymis or testes and ICSI pro- intra uterine insemination, utilising the husbands sperm vides fertilisation, even in cases of severe sperm poses no problem for Muslims. However, procurement abnormality. of the semen by masturbation and even worse, the use of erotic films to facilitate the success of the procedure, Ovum Donation is repugnant to say the least and is frowned upon by Infertility due to a failure to produce healthy eggs Islam. More recently, male packs which utilise sper- remains a problem in anovulatory and older women, micide-free, special condoms and coitus with the wife premature menopause, fertilisation failure and in those to produce the sample, obviates this. with recurrent miscarriages. Ovum donation gives hope for these unfortunate couples. Islam however In Vitro Fertilisation (IVF) prohibits the mixing of geneology and confusion of In 1978, for the first time, the fallopian tubes were family lineage and therefore ovum donation is unac- by-passed in conception and in vitro fertilisation ceptable. But in cases of polygamous marriages, could became a reality; the egg was fertilised outside the one co-wife donate to the other; strictly speaking, there body (in vitro) and the resulting embryo was trans- is no mixing of genes outside the marriage, no confu- ferred into the womb of the mother. In vitro fertilisa- sion of family lineage, the conception is still within the tion, poses no special problems for Islam, as there no marriage contract, albeit in a different sense, the moth- infringements of Islamic principles. Though it er is the woman who nurtures and delivers the baby appears to contravene Gods design and interferes and the father is the same; which are the reasons nor- with his plans for conception and creation, the schol- mally given for its non-acceptance. This issue remains ars have approved this on the grounds that the suc- unresolved; so does the issue of a Muslim woman cess of these new technologies are only by the will donating eggs to a non Muslim. and barakah (grace) of Allah. Embryo Donation Foetal Reduction Embryo donation is necessary where the husband As a consequence of transferring multiple has no sperms and the wife has no eggs, or where one embryos, particularly in the U.S.A., triplets, or other has no gametes and the available gamete is quadtriplets and higher-order multiple pregnancies fertilised by a donor sperm or egg, and the resulting creates a problem of extreme prematurity and mater- embryo is transferred into the womb of either the nal distress. Foetal reduction can by invasive means wife or surrogate. This is prohibited because of mix- under ultra sound, reduce the number to a single or ing of genes and family lineage. What then is the twin pregnancy. While Islam may sanction this for position in a polygamous relationship? Can a co-wife saving the mothers life, it should and could be avoid- donate the egg, have it fertilised by the common hus- ed by curtailing the number of eggs and more impor- band and the embryo transferred to the other wife,
40 JISHIM 2004, 3 ISLAMIC MEDICAL ETHICS IN ASSISTED CONCEPTION Farouk MAHMOUD who will nurture and deliver the baby? The recipient couraged and a time limit should be imposed. of the embryo who nurtures and delivers the baby Embryos should be destroyed in the event of a will be the mother, in concordance with the following divorce or death. Whether embryos could be donated verse. for research is another issue which awaits the Fuqahas response. None can be their mothers except those who gave them birth Q: 48:2 Surrogacy The pregnancy would be within the family and Where the mother has no womb or a womb which under the marriage contract and the mixing of genes cannot nurture a pregnancy, the embryo is transferred and family lineage are restricted to the extended to the womb of a surrogate, who would hand over the family. These are intricate and difficult questions for baby to the contracting couple. Surrogacy may be which answers are still awaited; the same holds for a partial where the husband contributes the sperm and Muslim couple who wishes to donate surplus gestational or full, where the surrogate provides no embryos to other gametes which are derived from the husband and wife. Though gestational surrogacy was permitted, Unused Embryos this permissibility has since been withdrawn by the It is common practice for surplus embryos to be jurists. The reason is possibly that nurturing and either donated, discarded, destroyed, stored or used delivering the baby confers motherhood, rather than for research according to the wishes of the couple. To biological, genetic contribution and procreation is date Islamic Fuqaha (jurists) have paid little heed to outside the marriage contract. This caveat notwith- this aspect of reproductive medicine and the status of standing, there is some justification for considering the embryo. Are embryos living beings, do they have surrogacy as a form of adoption. It is true that Islam any rights and are they entitled for protection from does not recognise adoption in the conventional harm? Islam considers any part of the human body as sense, stipulating that the genetic father or his name, precious and sacred. It is surprising that the product must be retained as the father. Of course in gestation- of the union of sperm and egg, producing a living al surrogacy, the sperm comes from the father and potential human, albeit a miniature one, has therefore he is the genetic, biological and the rearing received scant respect and attention by the jurists, to father. So there should not be a problem of the com- date. Embryos are stored away encapsulated and missioning couple adopting this baby from the sur- frozen in steel cylinders, perhaps, never to see the rogate mother. Also. What is the situation of a co- light of day; evoking Huxleyan nightmares of little wife in a polygamous relationship being the surro- genies, hibernating in hatcheries all over the globe. gate. After all, the conception is within the marriage The concept of pre embryo; which has been pro- contract; modified perhaps but still within the same family. If the co-wife is agreeable, she is like a wet posed to salve the conscience hardly solves the ethi- nurse who provides succour to the foetus in-utero. cal issue. From a pragmatic viewpoint, it has to be conceded that an embryo is different to that of a growing foetus in utero. It is also true that there is no Pre Implantation Genetic Diagnosis guarantee of implantation and growth into a foetus. (PGD) While this may be true, the embryo has at least the PGD is an ingenious technique whereby the early status of a potential human and therefore, merits embryo is tested for chromosomal or genetic abnor- some respect and dignity. Maybe the answer is to per- malities, and the normal embryo chosen for transfer. mit all surplus embryos to be donated to infertile non- It is an excellent alternative to conventional pre-natal Muslim couples. If this is not permissible, perhaps, diagnosis and obviates the necessity of an abortion. the number of eggs produced should be tailored to the stage is set for a revolution in functional give two healthy embryos. If despite this, there are genomics and human genetics Central to this revo- surplus embryos, indefinite storage should be dis- lution will be the gene chip, with the potential to iden-
JISHIM 2004, 3 41 Farouk MAHMOUD ISLAMIC MEDICAL ETHICS IN ASSISTED CONCEPTION tify genetic variation Continual development and cells ability to generate additional stem cells improvement of existing gene chip technology will generate differentiated cell types with specific func- enable to identify the genetic basis of male and tions a substantial amount of reprogramming female infertility The identification of an individ- between cell fates is possible(2) uals genetic blueprint at birth will provide the clini- The therapeutic potential is enormous; damaged cian with powerful tools to assess disease risk (1). or diseased organs could be replaced viz. spinal cord From an Islamic perspective, this pro-active tech- injury, diabetes mellitus, Parkinsons disease, car- nology is desirable but poses two problems. There is diomyopathy, stroke victims, arthritis and others. In potential damage to normal embryos and does the the field of research, it could provide a window for discarding of affected embryos create an ethical observing embryogenesis, teratogenesis and embryo- problem. This is another area the jurists are yet to toxicity. Does Islam permit the use of surplus IVF comment. It must be emphasised that though this embryos for research. technique affords sexing, Islam prohibits choosing of the sex. Discussion He creates what he wills. He bestows female The aim of this article is to address the question of (offspring) upon whom he wills and bestows male alleviating the anguish and grief of the barren couples (offspring) upon whom he wills. Q 43:49 who need one or other of the newer technologies of assisted conception. The infertile couple look Cloning-Islam - Baby from towards assisted conception as their last resort and do Both Man and Woman deserve sympathy and understanding of their need to In cloning, the nucleus from a somatic cell, is procreate It is important to recognise that the religios- injected into an enucleated egg and thus an embryo is ity of the couple would dictate the need for religious artificially created. The nucleus could be obtained blessing of a particular method of assisted concep- from the husband, albeit a skin cell (not from the tion. Also, we are aware that among those who cross sperm) and injected into the enucleated egg of the borders to overcome legal restrains in their home wife and the zygote is transferred into the womb of states, some are Muslims. However, among Muslims the wife. Genetically, the offspring will be identical it would be true to say that even non-practising mem- to the father, for the mother contributes no genetic bers would still lean towards a Sharia-compatible material except mRNA and mitochondrial DNA from method to salve their conscience. Some Sufis who the cytoplasm. There is no mixing of genes, no con- would adopt a passive stance and leave it in the hands fusion of family lineage and the pregnancy occurs of Allah but the Prophet (SAWS) promoted the seek- under the sanctity of marriage and the mother nur- ing of a cure with the following statement tures and delivers the baby. For every disease (except old age), God has pro- Though the wife takes part in the genesis of the vided a cure. offspring it does not contribute any genetic material. While it is true that despite what man attempts to Although ethically, human cloning is not acceptable, do, Allah determines the final outcome what is the Islamic perspective? Also, can these clone embryos be used for research purposes? The concept Allah may grant to mankind, none can with- of cloning poses an interesting, or rather, tantalizing hold it; and whatever He may withhold, none can dilemma for the jurists of Islam. grant it thereafter Q 35: 2 Therefore Allah will grant progeny or leave barren Stem Cell Technology as He wills. The Quran and the Prophet certainly Stem cells which are totipotential could be promote procreation and so does the Prophet. Marry, obtained from the inner cell mass from surplus IVF procreate and abound in number. It has been sug- embryos or generated by cloning adult cells. Stem gested that assisted conception, particularly in vitro
42 JISHIM 2004, 3 ISLAMIC MEDICAL ETHICS IN ASSISTED CONCEPTION Farouk MAHMOUD fertilisation methods, interfere with nature and Gods this, the status of embryos remains in limbo, as a means work. But this has been refuted with the argument to an end. Though polygamy may provide an accept- that when man succeeds, it is because of Allahs able solution to the question of ovum donation or sur- barakah (grace). rogacy, it is not an answer that would be welcome today; the author certainly would not advocate it and The Quran is immutable and so are the authentic even Muslim countries are making it illegal, except in ahadith. Therefore, the jurists have to find answers to special circumstances. Polygamy has been mentioned resolve reproductive issues in the Quran or hadith; if above as an intellectual exercise, rather than a solution. this is not available, Ijma, Qiyas or istihsan, istislah Does Islam permit the donation of surplus ova and or urf may help arrive at a solution. embryos to other infertile couples, non-Muslim of A Fatwa is not binding and a Muslim could get a course; after all, it is a potential life and why not some second or third opinion (fatwa). While this is gener- other barren couple be denied the joy and happiness it ally desirable, as a form of independence of Islamic could bring? thought, it does leave room for variance and non-uni- Finally, what is the Islamic position regarding the form resolutions. Perhaps, after the preliminary us of surplus embryos for purposes of research? deliberations by individual jurists, a final resolution Being eclectic, Islamic medicine utilises the research in a central global, Fiqh academy may lead to unifor- done by others. Why should we not contribute mity. towards it? Conclusion This article highlights some areas of reproductive REFERENCES medicine which are not in concordance with Islam. 1. Cram D., Kretser D. Genetic diagnosis: The Future in Cryo-storage of embryos serve a useful function in Assisted Reproductive Technology-Accomplishments and maximising IVF whereby the yield of a single attempt New Horizons. Chapter 12. Cambridge University Press could be used for transferring embryos many times 2002: 202. over and as and when one wishes to. Moreover, 2. Lawler A.M., Gearhart J.D. Embryonic Stem Cells in Assisted Reproductive Technology-Accomplishments and embryos or gametes (sperm and ova) could be pre- New Horizons Chapter 10. Cambridge University Press served prior to radio or chemotherapy. Notwithstanding 2002: 167-8.
JISHIM 2004, 3 43 Medical Ethics in Medieval Islam*
Plinio PRIORESCHI*
* MD, PhD, Department of Pharmacology, Section of History of Medicine, School of Medicine, Creighton University, Omaba, Nebraska 68178, USA e-mail: [email protected]
Summary The author discusses medical deontology in medieval Islam. After reviewing the work of al-Ruhawi and other Islamic ethicists, he notes that in medical ethics, as in medicine and other sciences, Islamic civilization, at the time, reached levels unsurpassed any- where. Key Words; Islamic Civilization, Ethicists, Medieval Islam.
As we have seen elsewhere (1), society confers on this condition and are sworn to the medical nomos (1) the physician special trust and privileges (e.g., to participate together in exhortations and learning knowledge of confidential information, examination and all that has to do with the science, but for nobody of the most intimate parts of the body), but it requires else will I do so. in return that he adhere to principles of behavior During the entire treatment, I will strive, as far as it expressed in codes which are common to many cul- is possible for me, to benefit patients. Things that may tures. In the Western World, such a code was (and, to harm them and do them wrong I will avoid to the best a certain extent, still is) (2) the Hippocratic Oath. of my judgment. I will not give a lethal medicine if The Islamic world was no exception and treatises asked for it nor give such counsel. Similarly, I do not of medical ethics were common. (2) The Islamic believe that I may give women an injection [i.e., give physician also recognized the validity of the a drug or perform a procedure] to induce abortion. In Hippocratic Oath, which was translated and adapted my treatment and my science I will keep myself pure to the Islamic religion (in the same way it was modi- and clean. Also, I will not make an incision for some- fied in the West to reconcile it with Christianity (3)). one who has a stone in his bladder, but will leave it to The Arabic version of Usaybia reads: those who perform this operation professionally. I swear by God, Master of life and death, giver of All the houses that I enter, I will enter for the ben- health and creator of healing and every cure, and I efit of patients, being in a condition far removed from swear by Asclepius, and I swear by all Gods saints, injustice, wickedness and voluntary and deliberate male and female, and I call on all of them as witness- corruption in general as well as in respect of sexual es that I will fulfil this oath and this condition. intercourse with women and men whether free or slaves. Things concerning peoples activity which I I believe that he who instructs me in this sciences observe or hear during the treatment of patients and takes the place of my fathers. I will let him share in at other times and which ought not to be discussed my livelihood and, should he need money, I will give outside I will avoid, since I believe that one should it to him and let him participate in my income. I will not talk about such matters. consider the generation of his descendants as equal to my brothers and I will instruct them in this science, He who keeps this oath and does not corrupt it in should they need to learn it, without payment and any respect will be privileged to perfect his treatment without condition. I will allow my children and my and his science most excellently and beautifully and teachers children and the pupils who have accepted will be constantly praised by all men in future. The
44 JISHIM 2004, 3 MEDICAL ETHICS IN MEDÝEVAL ISLAM Plinio PRIORESCHI opposite applies to him who breaks it (Nomos is the C. Iffah, to possess abstinence, chastity with rule to follow, the law, the guiding norm. In this purity and decency with integrity and modesty. case, the rules mentioned in the Oath). He should protect himself against the following The reference to Aesculapius, at first surprising, vices, evils, malpractice and wickedness: must be understood in the light of the fact that in the 1. Al-fujur, meaning debauchery, licentious- Islamic world Aesculapius was not a god, as he was ness or fornication. among the Greeks, but simply the legendary originator 2. Al-khubth, which means in Arabic malevo- and discoverer of medicine (4). It is to be underlined lence and malice. that Usaybia, like al-Ruhawi, interprets the prohibition 3. Al-danaah or al-danawah, meaning lowli- to perform surgery as limited to the cutting for the ness, vileness and meanness or dishonest. stone and not to surgery in general (see below). 4. Al-ghadab, wrath, anger or indignation. The oldest known surviving work in Arabic on 5. Al-jaza, anxiety, anguish and apprehension medical ethics is al-Ruhawis Adab al-tabib, or uneasiness. (Practical Ethics of the Physician or Practical 6. Al-Shahwah, craving, greed, carnal appetite Medical Deontology), (5) which is based to a great and lust or sexuality. extent on Hippocrates and Galen. In addition, the author listed the six following vir- Al-Ruhawis place of origin was most likely Ruha tuous traits that the physician should possess: (al-Ruhawi means the one from Ruha), which was 1. The physician ought to be miqdam, that is to the old Edessa and is today Urfa (Turkey). A physi- be bold, daring, fearless and audacious. cian, he was a converted Christian, (6) who practiced 2. He must be shuja, courageous, brave and in several cities of the Islamic world including valiant as a hero. Baghdad. He wrote several works of which only the 3. Be afif, chaste, decent, modest and pure in Adab al-tabib survives. heart. In it, he underlines the qualities that the physician 4. Be sabur, patient or long-suffering, forbear- is expected to have and the vices and evils that he ing and forgiving, steadfast, tolerant and perse- should avoid. The work also deals with every aspect vering. of the physician-patient relationship, e.g., respect and 5. Mutamassik bil-haqq, to be always just and confidentiality and developing mutual trust. Its con- fair, unprejudiced, equitable, straightforward tent is summarized by Hamarneh: and candid. 6. Finally to be waqur, dignified and stately, 1. The physician ought to be always hasib, that venerable and reputable (6). is honest, generous, noble of character, and righteous who seeks Gods favor and mercy. The following is a quote about inducing abortion: 2. He should be alim, that is proficient, learned, you must not mind the impatience of a woman savant, capable and skillful. whom you see distressed and afflicted due to her ges- 3. He ought to be wari, a pious and God-fear- tation, and not pity her or give her a remedy to make ing devotee or a deeply religious person. her fetus fall. Whoever does so has no fear of God 4. To be ghayr ajul, that is to take his time and As to a bad mother, do not show any compassion not to be in a rush but rather be congenial. The for her so that her shame will cause the improvement physician further must possess three traits: of many other women. Beware of giving things [i.e. A. Aql, to have a sane mind, reason, common abortifacients] like these; they are prescribed only if sense and intelligence; you fear the death of the pregnant woman or the B. Razanah, that is having self-control, sober, fetus. There is no difference whether you administer calm and composed, sedate and serious; and the drug or you buy it. Before deciding on the drug finally, treatment, it is essential that you read the book of
JISHIM 2004, 3 45 Plinio PRIORESCHI MEDICAL ETHICS IN MEDÝEVAL ISLAM
Hippocrates in regard to his oaths to carry out his both in action and appearance so that people will be word. You must adhere to his oaths and go along with convinced There is no honesty in their treatment of his beliefs from which the oaths are derived since the ill or in the maintenance of [the health of] well these belong to the art of medicine. These must be people; on the contrary, their activities cause illness observed under all conditions (7). of healthy ones. As was stated previously, some of And this about quacks: them practice splitting, cauterization, etc., forcibly handling organs when it is unnecessary. They cause Since medicine is the greatest in value of the arts illness in the healthy so that treatment and curing are for the benefit of man, its legitimate practitioners are necessary for a long time - even to the point of of a noble and high rank, respected by the people. death.This is not among Galens known works and Further, this art is confined to a private group; it is not the name Efihanes is not found in Galenic literature. possible for everyone who seeks it to enter it. People, by their nature, like to be in the upper class and to be Concerning remuneration, al-Ruhawi suggests applauded; in this, there is no art above that of medi- that the rich should be charged enough for medical cine. It attracts the jealousy of those who have suc- treatment to allow the poor to be treated for a small ceeded into the high rank by the unsuccessful ones fee or none at all (6). who have evil complexions and error in their inborn It is of interest to quote al-Ruhawis interpretation dispositions. Thus, they return to [the use of] cunning of the passage of the Hippocratic Oath about surgery against the people with many kinds of deceit. (6,7): You may see them in dress and garb like legiti- It is necessary that you obtain the advice of mate physicians; the same is true for the way they Hippocrates who gave this admonition, I do not visit speak and in most of their affairs. They embellish one who has a calculus in his urinary bladder; on the their offices and exhibit their instruments to hunt for contrary I leave him to one whose area is this special- people as in setting a trap or a net for beasts. Because ty. It is not necessary for you to do this except in a case of this calamity which intrudes in this art among its of calculus distress. In similar ailments as that of the practitioners, there arises doubt of some of them. As eye [this is also true]. There are people who specialize a result, they are exposed to evil opinion by many in these occupations so that you need not practice what people. Galen, in his book, On Wonders in the is not in your field; this would only harm the ill (1). Superiority of Knowledge said, As to what many It is evident that al-Ruhawi, like Usaybia, clearly physicians see, O Efihanes, it is impossible for one to realized that the Oaths prohibition about surgery proceed to warn about what happens to the ill, one by referred only to the cutting of the stone and not to one. This is because, the busier a physician is, the fur- surgery in general (6). In addition, it is worth noting ther his conjecture is from the truth. This is a fact not that the prohibition against the cutting of the stone is only in medicine but in other arts. (6). interpreted by al-Ruhawi as an exhortation for the There are people who set out to become famous. physician to seek the help of the more skilled unless They learn to speak well, act well, incline toward the patient is in acute distress. pleasure, blandishment, and permission with bowing Very often, the ethical rules for the physician were and submission every day to the wealthy and the city associated with the ideal physical characteristics that authorities; they escort them from region to region, the physician was supposed to possess. Ibn Hubal go out to meet them when they come to the country, (1117-1213), (1) in his Kitab al-Mukh tarat fi l-tibb and use cunning and laughter in groups. Some of (Book of What is Best in Medicine, also referred to these people are not content with these things but as Anthology of Medicine), described the desirable they also attempt to convince the public that they physical characteristics of a doctor: deserve expensive dress, beautiful rings, many com- panions, and silver vessels Their purpose in gener- Regarding what should be desired in a student of al is to conduct themselves like legitimate physicians this profession, he should be of attractive appearance
46 JISHIM 2004, 3 MEDICAL ETHICS IN MEDÝEVAL ISLAM Plinio PRIORESCHI and shape. He should be in good spirits, neither When a doctor treats the ailments of the wealthy frowning nor scowling. People should look forward and they are in severe pain, he can make what finan- to seeing him, smile when speaking with him and cial conditions he likes, and when he knows that his when flocking to him. He should be of moderate patients will carry out their bargain, it is then his stature, neither fat nor lean, If not, leanness is better. responsibility to produce the cure. The money that he He should have a light rosy complexion if he is from earns should be spent on such useful ends as befits a country where such a complexion is found. His him. I mean on the assistance of relatives, charitable forehead should he wide in proportion to his face and acts and the purchase of drugs suitable for curing dis- there should be a wide area between his eyebrows. ease. Nor should he refrain under any circumstances His eyes should be bluish black and appear as if they from tending the poor and associating with them (1). are laughing or always looking at something pleas- Al-Ruhawi holds approximately the same views ant. They should be of moderate size, neither protrud- and asserts that the physician should earn enough so ing nor indented. If not, indentedness is better. A per- that he does not need to do anything other than practice son with such eyes should seem mild and not over- medicine, and so that he can marry, afford proper food, bearing. His tears should not be visible. Such a per- clothes and housing (11). As we have seen above, he son should have facile cheeks, a small jaw, and sparse also states that the wealthy should pay sufficient fees beard of moderate length which is neither curved nor so that the physician may take care of the poor. inclined to the shoulders. He should have long upper In spite of all that, accusations of greed on the part arms, large hands with delicate edges and little flesh of physicians are fairly common in medieval Islamic on the palms and long fingers. He should have literature (6). The accusations may not have been smooth buttocks, moderately fleshy thighs, straight completely unfounded, as Ibn Ridwans criticisms of legs, and discernible arches in his feet. His feet his colleagues indicates (12). A story in The Arabian should point exactly in the direction that he walks Nights relates that a doctor, when told in the middle and he should have a light deliberate walk (8,9). of the night by his servant that a patient waiting As we have noted elsewhere (10), Ibn Abi downstairs to see him was prepared to pay a quarter Usaybia wrote similar normative rules (including (of a dinar), became so excited that he sped down the desirable physical characteristics) for the physician. staircase without taking a lamp and in the darkness In essence, all authors dealing with medical ethics ran the patient over and killed him (or, rather, emphasize those qualities that society expected from believed he had killed him) (13). physicians, which are similar to those expected by This brief review of medieval Islamic medical other societies in other times (1). ethics (14) indicates that, as in medicine and other As for medical fees in Islamic medicine, the sub- sciences, the Islamic civilization, at the time, reached ject has not been systematically investigated. We levels unsurpassed anywhere. know that physicians were, in general, relatively affluent and that their average income was probably REFERENCES comparable, as mentioned above, to that of the afflu- ent merchant and shopkeeper. On the other hand 1. Prioreschi P. A History of Medicine. Volume II. Greek there was the possibility for prominent physicians to Medicine. Chapter V,B,i. Second Edition. Omaha: Horatius Press, 1996, accumulate considerable fortunes. This, of course, 2. Prioreschi P. A History of Medicine.Volume III. Roman led to ethical dilemmas concerning the medical pro- Medicine. Omaha: Horatius Press, 1998. fession and money, especially in view of the fact that 3. Savage-Smith E. Medicine. In: Rashed R editor. Islam enjoined the charitable treatment of the poor. Encyclopedia of the History of Arabic Science. 3 Vols. According to Ibn Ridwan, a man should study medi- London: Routledge, 1996: 903-962. cine with the intent of acquiring the art and not 4. Ibn Abi Usaybia, Uyunu al-Anba fi Tabaquat al-Atibba, I, 25-26. Quoted by Rosenthal In: Franz Rosenthal, The money, but this did not mean that he should neglect Classic Heritage in Islam, Berkeley: University of the possibility of making money: California Press, 1965:183-184.
JISHIM 2004, 3 47 Plinio PRIORESCHI MEDICAL ETHICS IN MEDÝEVAL ISLAM
5. Ullmann M. Islamic Medicine. Edinburgh: Edinburgh 10. Leser G. Medical Education in Islamic Lands from the University Press, 1978: 30. Seventh to the Fourteenth Century. Journal of History of 6. Al-Ruhawi, Adab al-Tabib, translated by Levey, In: Martin Medicine and Allied Sciences, XXXVIII, 1983:48-75. Levey, Medical Ethics of Medieval Islam with Special 11. Lyons MC. The Kitab an-Nafi of Ali ibn Ridwan. Islamic Reference to Al-Ruhawis Practical Ethics of the Quarterly, 6, 68-69, 1961. Quoted by Dols In: Ibn Ridwans Physician, Philadelphia: The American Philosophical Treatise On the Prevention of Bodily Ills in Egypt, trans- Society, 1967:8,12,56-57, 88-89. lated by Michael W. Dols, Berkeley: University of California Press, 1984: 38. 7. Sami Hamarneh, Yunani (Unani), Arabic and Islamic 12. Biesterfeldt HH. Some Opinion on the Physicians Medicine and Pharmacy, Karachi: Hamdard Foundation, Remuneration in Medieval Islam. Bull. Hist. Med., 1984; 1997: 67-70. LVIII:16-27. 8. Muhadhib al-din Abu-l-Hasan Ali ibn Ahmad ibn Ali ibn 13. Ibn Ridwan. Treatise On the Prevention of Bodily Ills in Hubal al-Baghdadi ( Ibn Hubal). Kitab al-mukhtar fi-l-tibb Egypt, translated by Michael W. Dols, Berkeley: (Kitab al-Mukh tarat fi l-tibb). In: Koning P, Leiden E J. University of California Press, 1984: 38. Brill, editors and translatation. Abu Bekr Muhammed ibn 14. The Arabian Nights, Night 25 (Story of the Hunchback), Zakariya Al-Razi, Traité sur le calcul dans les reins et dans quoted by Goitein in: S. D. Goitein, A Mediterranean la vessie, 1896: 186-227. Society: the Jewish Communities of the Arab World as 9. Sarton G. Introduction to the History of Science. Baltimore: Portrayed in the Documents of the Cairo Geniza, Berkeley: William & Wilkins, 3 Vols. (in five), 1927-1948: 430-431. University of California Press, 4 Vols., 1967-1983, II: 257.
48 JISHIM 2004, 3 Some Notes About the Influence of Arabian Medicine in New Spain
Rolando NERI-VELA*
* Department of the History and Philosophy of Medicine Faculty of Medicine National Autonomous University of Mexico, National Academy of Medicine Mexican Academy of Surgery, Mexico e-mail : [email protected]
Summary New Spain was a viceroyalty of Spain between 1521 and 1821. In this three centuries, the practice and the teaching of medicine had a great influence from Arabian medicine, because of the action of Arabs in Spain from VIII to XV centuries. I will try to do some reflections about it. Key Words; Medicine, Arabs, Avicenna, New Spain.
New Spain was a viceroyalty, part of the great Viceroyalty, and at the same time, it is rare the book Spanish empire during three centuries, from 1521 to from Renaissance that didnt include the Avicenna 1821. Its territory was occupied for part of the actual theories in its texts. United States, Mexico and Central America. Bravo didnt say which of the Avicenna editions When Hernán Cortés conquered the Aztec king- consulted although he pointed treatises and chapters dom, began a new life into the medicine, because of the work Canon, the most well known work from European medicine was mixed with aboriginal. The Avicenna was, between XVI century. Spanish med- Spanish science, in that times, was mostly medieval, ical doctors, an important work of consult, that was and so, was medicine. The medical, surgical and interpreted and informed in medical schools, simulta- pharmacological practice were in delay if we com- neously with Galen and Hippocrates. pare it with the northern medicine of Europe. (1) There were many editions, but incunabula were Surely all Spanish physicians who crossed the twenty, almost elaborated about the classical transla- ocean carried in their luggage the essential biblio- tion from Gerard of Cremona, in XII century. graphical material for their profession., all of them At the beginnings of the XVI century, in 1523 faithful to the knowledge of Avicenna. was published at Venice Praesens maximus codex est In the same books that edited Mexican presses we totius scientiae medicine principis Alboali Abinsene, can know which one were. Francisco Bravo, who monumental typographical work, and the most com- arrived to New Spain after he had studied in Alcalá de mented edition from the Persian physician, in whose Henares and Osuna universities, in Spain, wrote the interpretation supervised the most noted Italian doc- first medical book edited in America, named Opera tors of that times. It was an important book and Medicinalia, and cite, between others, authors like arrived to almost Spain medical centers. A copy of Galen, Avicenna, Rhazes, Hippocrates, Thucydides, this work was used in the ceremonies at Alcalá de Valles and Fracastoro. The works of Galen, Henares to point out the themes for the grade exam. Hippocrates and Avicenna were indispensable books During the XVI century there were in Spain the for all medical doctors, and were edited many times. Epitome or Compendium from Avicenna that was About the works from Avicenna that came to New drafted by Miguel Capella, and Prima primi canonis Spain, we have a few notices. Avicenna was an Avicena section, written by Miguel Jerónimo de author cited for all who wrote medical books in the Ledesma, Valencian lecturer, that although only
49 JISHIM 2004, 3 Rolando NERI-VELA SOME NOTES ABOUT THE INFLUENCE OF ARABIAN MEDICINE IN NEW SPAIN translated and commented the first book from the century, when the properties of Catholic church Arabian author, was successful. changed owner, being the Mexican government the Probably this two works arrived to New Spain, for proprietary of the monasteries so all the monks the teaching of medicine at the Royal and Pontifical books were then part of the State. But returning to our University, founded in 1553, and its Faculty of theme, the New Spain authors included the teachings Medicine, that opened his doors in 1582. of Arabian masters in their works. Fifty years ago Dr. José Joaquín Izquierdo, a very Juan de Cárdenas in his work Primera parte de los distinguished Mexican physician, found in the problemas y secretos maravillosos de las Indias National Library of Mexico, which is managed by the (1591) is sparing in appointments, but he names the National Autonomous University of Mexico actually, a classics, Avicenna, between them. copy of Liber canonis de medicines cordialibus et can- Agustín Farfán wrote in 1592 Tractado Brebe de tica, from Avicenna, edited by Joan Hervagios in 1556. Medicina, and in this work he quoted Galen, The frontispiece is shown in this article, as well as a Hippocrates, Rhazes and Avicenna., in an abstract page about ocular disorders (figs. 1 and 2). The exis- tone and without interest.. tence of this book in Mexico could illustrate about the Avicenna used in the XVI century by New Spains The anatomy was studied on the works of doctors. Another book from Avicenna, Disputatione Avicenna, complemented with the old authority of medicae, printed by Pedro García Carrero at Alcalá de Galen, commented by Rhazes. Supported in the Henares in Juan Gracianis press, in 1611, was found- authority of the great philosopher and Arabian- ed by Izquierdo, too., in the same Library. Spanish scientist, Farfán said in his Tractado that the bones of the human body are 148, and the muscles It is important to point out that the National 531. In addition, students should studied, during the Library of Mexico was integrated during the XIX third year, the ninth book of Rhazes Almanzorem.
Frontispiece of Liber canonis , by Avicenna. Avicenna, op. cit, chapter dedicated to ophthalmology.
50 JISHIM 2004, 3 SOME NOTES ABOUT THE INFLUENCE OF ARABIAN MEDICINE IN Rolando NERI-VELA NEW SPAIN We have to remember that the medieval therapeu- Rhazes, Averroes and Mesue. In the third year of tic methods were purges, cupping-glasses, draughts, studies the students had to study the ninth book of Ad plasters, cauterizations and various infusions. Then, almanzorem, from Rhazes. in those times was used the called soliman water, to Later, when medievalism was substituted for the cauterize a sweet sublimate of mercury diluted in modernism in the Spanish universities, they contin- water, insipid and which first known prescription is ued with the lectures from Avicenna (2, 3). founded in Summa perfectionis writed by, Geber, Arabian alchemist whose work was known by To finish these notes, I will mention some ideas Avicenna., and too, in New Spain. Another Islamic from the book Verdadera Medicina, Astrología y knowledge used by doctors in New Spain was the Cirugía, from Juan de Barrios, published in Mexico bezoar stone, effective antidote. in 1606. In New Spain, Enrico Martínez, astronomer, but no Juan de Barrios arrived to New Spain in 1590, physician, wrote Repertorio de los tiempos, y historia after attending the universities of Alcalá, Salamanca natural desta Nueva España in 1606, and in the fourth and Valencia, and his work is, probably, the most chapter he treats about the applicability of astrology, important monument of New Spanish medicine, writ- and in his book he mentions Avicenna and his Canon. ing in dialogue form. In the chapter number 17 of the third treatise of his book, de Barrios illustrates about By the sea, sometimes arrived to American coasts the headache and hemicrania. saying that Avicenna ships with boxes full of books; some works were for- thought that this disease was so terrible and ferocious bidden by the Holy Inquisition, but some medical doc- that the joins of the head looked dilate, and it opened tors had got some of them. In a list of the year 1576, the head, and it was so tyrannical that sometimes it Alonso Losa, a bookseller, received two copies of killed (4). When de Barrios treats about cataracts, in Exposición sobre las preparaciones de Mesue, pub- chapter 28, mentioning Avicenna, says that to heal it lished in 1569 by Antonio de Aguilera from Alcalá de the physician must use warm and dry air, the patient Henares, in which the author explains the book of Juan must not drink wine, only cinnamon or honey water, Mesue, the Arabian physician whose works were used and they can eat hen, kid, and they must not drink till the end of the XVIII century. Mesue is named with milk nor eat fish (4). profusion in Juan de Barrios book, Verdadera medici- na, cirugía y astrología, published in 1607. So, I had expose briefly the influence and the util- ity of Arabian medicine in Americas medicine, There is other incunabula in the National Library pointing out some of the authors that had more of Mexico, that is a latin translation of the works of authority on physicians during the three centuries Serapione, Liber serapionis agregatus in medicines Colonial Mexico. simplicibus translaton Symonis Ianuensis interprete Abraan iudeo tortuosiensi de arabico in latinum inquit Serapion, published in 1473 at Parma by REFERENCES Antonio Zarotum. 1. Weckmann L. La herencia medieval de México, II. El In 1648 Juan de Correa, an anatomist in the Real Colegio de México. México, 1984: 669-687. y Pontificia Universidad de México wrote Tratado de 2. Francisco FC. La Facultad de Medicina según el Archivo de la qualidad manifiesta, que el mercurio tiene , in la Real y Pontificia Universidad de México. Imprenta Universitaria. México, 1953. which he treated about the life into the mines, and the 3. Francisco F. Historia de la medicina en México desde la poisoning with sulphur. To do this book, he read época de los indios hasta la presente, vol. 2. México. Avicenna and Geber. Oficina Tipográfica de la Secretaría de Fomento. 1886: 95. In XVI century New Spain, the texts for the 4. De Barrios J. Verdadera Medicina, Astrología y Cirugía. Imprenta de Fernando Balli. México, 1607: 68r, 72r. Faculty of Medicine were the books of Hippocrates, Biblioteca Nacional de México, Fondo Reservado Galen, Ali Abbas, Hunain Ibn Ishaq, Avicenna, Clasificación R 610.953F AVI.I
JISHIM 2004, 3 51 Al-Razi and Gastrointestinal System Diseases
Radhi Javad BAKIR*
* M,B;Ch,B D.L.O., Head of the Department of Otolaryngology Al-Zahraa (Al-Ku) General Hospital Wasit, Iraq e-mail : [email protected]
Summary This is a review of the theories and opinions proposed by a well scientifically recognized doctors at the time of Arabic-Islamic civilization era who paved the way to the modern scientific achievements and it is at the same time the continuation of the very old human heritage. Al-Razi (865 A.D) the second greatest clinician after Galen in the history of medicine, had written some of the opinions about G.I.T illnesses (part of these are according to his own experiences) in his famous book Al-Mansuri, which was the text book in the Arabic-Islamic and European universities for several decades. Key Words; Al-Razi, Gastro Intestinal Diseases, Al - Mansuri book.
Notes on Al-Razi Life G.I.T. Illnesses as Mentioned in Abu-Bakir Mohammed Ben Zekria Al-Razi was Al-Mansuri Book born in Al-Rai (Persia) (1) (865 A.D). He studied Al-Razi wrote about the anatomy of G.I.T in the banking, chemistry, music early in his life but his first chapter and in the following way; interest shifted to medicine, he studied, practiced and 1. The esophagus: It is considered as route which taught medicine in Baghdad and Al-Rai hospitals. He start just below the end of the oral cavity and had the honor to help in the establishment of one of descend behind the trachea and in front of the the earliest hospitals in Baghdad at the order of cervical vertebrates, it is fixed by bands, after Abbasid Caliph (Al-Muatadh). it pierce the diaphragm it bend to the left and Al-Razi had many achievements in medicine and dilate to form the stomach. chemistry among them: 2. The stomach: It is tilted by its head to the left * He was the first to differentiate clinically and by its end to the right it looks like (Pear), between measles and small pox against the old it is flat posteriorly and fixed by bands to the concept of being one illness. adjacent viscera for its safety. The end pas- * He was the first to use diuretics and laxatives sage is called the Door man as it control the in treating ascites. passage of food to the intestine, it closes when * He was the first to use Coal of animal origin to the food and even water enter the stomach to blench colors (2). keep it longer time for digestion. The wall of the stomach consist of three layers of fibers, Beside this he had left around (270) books (3) and longitudinal, transverse, and circular. articles in medicine, Chemistry, Astronomy, 3. The intestine: It consist of two layers the inner Philosophy, Religion and many other branches of sci- one is viscous: it is divided into six parts: three ence (4). are small intestine and the others are the large: Al-Hawi was the biggest and most famous book, A. duodenum (athni-ashri) it was considered a reference medical book since that B. jejunum (alsaam,_fasting): it has more time to the seventieth century both in Arabic-Islamic pores than the other, from it the food trans- and European universities (5). ported to the liver.
52 JISHIM 2004, 3 AL-RAZI AND GASTROINTESTINAL SYSTEM DISEASES Radhi Javad BAKIR
C. ileum (al dakik): it is coiled several times. cold) these two characters were to be identified to D. colon appendix (al -awar): it has one understand the nature of the illnesses and their prog- mouth (opening) and it is a sac on the right nosis and treatment). side of the body. These signs and symptoms include; E. colon (it is the same nomenclature used in Appetite, decreased or increased appetite and to Arabic): it starts from the right goes up and what type of food and who frequent. then goes transversely to descend to the Thirsty, headache, dizziness, angry or calm. left. H. rectum (al mastakeem -straight- ): it is a Belching; acidic or smoky. hollow wide cavity to collect faeces and at Stool, increased or decreased wet or dry, who fre- its end the anus to defecate under the con- quent. trol of the human being. Nausea and vomiting. 4. The liver: It is situated under the right lower Increased bile with discoloration of the urine or ribs to the posterior, it has a luminal figure stool. with convexity to the side of the stomach to Weakness, debility and wasting of the abdomen. embed the right side of the stomach. it has 4- 5 lobes, and its concavity is next to the Pallor or dimness of the general looking. diaphragum, from the convexity of the liver a duct arise called the liver door , and looks like Stomach Illnesses empty vessel it is the rudimentary umbilical 1. Weak stomach with indigestion: vein. The vessel which arise from the liver a. Indigestion with less thirsty and delayed pas- divide several times some go to the stomach sage of food with acidic belching and keeping others to the duodenum but most of them go to in consideration the duration of the illness the jejunum and to other intestine down to the whether acute or chronic. (Treatment: the full rectum to collect food materials from them. description of treatment will not be mentioned After that these vessels come together again to as to be dealt with in another article but it is reach the door of the liver , inside the liver it nice to say that in the treatment of some these divide again to be as thin as the hair from illnesses he mentioned to practice sports which the blood goes to the vessel at the dor- before meal). sum (concavity) of the liver which goes to the b. Indigestion with thirsty and lose of appetite heart. and fetor belching. 5. The spleen: It is elongated and located at the 2. Stomach aches: left side with (membranes and ligaments) to a. Stomach ache with anorexia. fix it to the stomach from the posterior side of b. Stomach ache with frequent belching with hic- the ribs. From the spleen two ducts arise one to coughs, distended stomach with borbgyomy. the liver the other to the mouth of the stomach. c. Stomach ache with fever with hot tender visi- 6. The gall bladder: It is located on the liver it has ble swelling: some time it may change to solid two (passages) one connected to the convexity swelling. the liver the other divide to reach the lower These illnesses were treated in general by tak- surface of the stomach and upper parts of the ing special diet, drugs, local ointment applica- small intestine. tion, dressing over the stomach, venisection, exposure to cold or hot and practicing sports or Diagnostic Criteria (signs and symptoms) the form of treatment. (N.B: the illnesses at that time were considered to 3. Hiccough: This illness happens after heavy meals, follow the mood of the human which were four: or over drinking heavy liquor, or after fever subsi- (bloody, yellowish, black, phlegram), and the dence, or with acute illness associated with nausea essences of the human being were four (wet, dry, hot, and thirsty ..it is nice here to say that he men-
JISHIM 2004, 3 53 Radhi Javad BAKIR AL-RAZI AND GASTROINTESTINAL SYSTEM DISEASES
tioned the valsalva maneuver as part of the treat- 2. Hepatic pain with pallor and diarrhea. ment and also by sneezing. 3. Surgical illnesses of the liver. 4. Hepatic abscess; if the abscess is situated under the Intestinal Illnesses capsule of the liver it will open and pus will descend 1. Intestinal colic (colonic): down to the site were the ascetic fluid collect and a. Belly aches with constipation and nausea with drained to the side of right inguinal region, if pus or without fever. come out keep it on by making good drain incision. b. Belly aches without constipation but with dis- In another article written in Al-Hawi of Medicine teneted abdomen, gasses and borbogymi. book (6) Al- Razi has described a condition simi- c. Bad intestinal colonic, total constipation, lar to hydatid cyst rupture: when the liver get punctured pain will occur with itching in the anorexia and vomiting, the fetor odor belching, mouth and posterior aspect of the head and the it may progress to faecal vomiting, this type of two first toes of the foot, and skin lesions as illness is fatal most of the times. beams will appear on his back, this condition will The treatment of these illnesses is by strict diet, lead to death with in five days. drugs, baths. application of ointment over the 5. Jaundice is a red discoloration of the urine and the abdomen, vein section, enema, suppositories. bile will not pass to the intestine but will keep 2. Frequent motion, diarrhea: with in the blood and excreted through urine. Two a. Diarrhea with propulsion of food after meal types of Jaundice are mentioned. with aches with thirst, with pus filled motions a. Jaundice with fever. in between the meals. b. Jaundice without fever. b. As in a, but with out aches with viscid materi- al motions. It is nice to mention beside the different ways of c. Watery-soft diarrhea and it is of two types, treatment he mentioned he prescribed the eye lashes. with signs of liver weakness, or without signs Most of the methods of treatment were by diet, fluid, of liver weakness. (cheese water), laxatives bathing beside other for of d. Yellow color diarrhea with burn sensation at treatment. the anus with thirst and fever. e. Diarrhea with intestinal ulceration with blood Ascites or without and with below umbilical pain. If the abdomen distended after liver pain and fever Treatment of diarrhea as mentioned to be by with evertion of the umbilicus and get whiter, thin- diet, drugs, fluid intake, cold and hot exposure, ner and smother, and if you shake the abdomen you local ointment application over the abdomen will hear water trembles it is fluid form of ascites. If and by vein section . the ascites was accompanied by dark colored urine it 3. Cholera (al hytha): This was considered in sepa- means it is a fatal condition. rate paragraph not included with other types of Types of ascetics: diarrhea, it is with a abdominal pain, with deteri- a. Fluid type of ascites; It is when fluid fill the oration as vomiting and diarrhea is followed. abdomen. Treatment was by giving fluid orally with cold b. Drum type; When air fill the abdomen, it look sponging on the legs and foot with local applica- like drum. tion of ointments over the abdomen, with cupping c. Fleshy; When the whole body will be swollen the stomach by large cup. including the face, eyelids, testes, it is diag- nosed by pressure by a finger. Liver Illnesses Treatment: In case of fluid, he used diuretics and 1. Hepatic pain with yellow discoloration of the skin laxatives in addition to the traditional ways of treat- with ill looking, dry mouth with sever thirst feel- ment. While in case of drum like he used discrimina- ing, pain to the right side behind the lower ribs. tive drug and diet.
54 JISHIM 2004, 3 AL-RAZI AND GASTROINTESTINAL SYSTEM DISEASES Radhi Javad BAKIR
Spleen Aches REFERENCES
1. Spleen pain with fever with bloody urination. 1. Ibn Abi Usaybia. Uyun Al Anaba Fi Tabaqat al Atibba. 2. Spleen pain with no fever. Beirut: Dar Maktabat Al-Hayat 1984. 3. Swollen spleen with crackles on pressing over it. 2. Al- Taai FA. The Famous Arabic Chemists. Baghdad: Dar Al - Hurria, 1981. This was all what Al-Razi mentioned about G.I.T. 3. Mahfooth HA. A Study on the Heritage of Al-Razi Center diseases in his book Al-Manssuri, but the treatment to of Arabic Scientfic History Baghdad University, 1988. these illnesses were omitted and to be written in 4. Epitre de Beruni. Contenet Le Repertoire Des Ouvrages De Muhammed B. Zakriya Ar-Razi. Paris: Publiet par Paul another article. To review these opinions is not only Kraus, 1939. for curiosity but because scientific facts and theories 5. Samarrae K. A Concise History of Arabic Medicine. Vol 1. are in chain and may need a revision at any time to Baghdad: Dar Al-Hurria, 1984. solve unsettled questions. 6. Naji Khalid. Al-Razi and Clinical Medicine. Center of Arabic Scientific History. Baghdad University, 1988.
JISHIM 2004, 3 55 Control Projest of Bejel (Endemic Syphilis) Disease in Iraq*
Kathem K. AL-RUBIAY*
* DHM, DTMH,. MSc. PhD., Department of Dermatology, College of Medicine, University of Bsxasrah. Basrah, Iraq. Po. Box. 289 e-mail: [email protected]
Summary Bejel, also known as endemic syphilis, is a chronic but curable disease, seen mostly in children. It is most commonly found in dry, hot climates countries of the Middle East (Syria, Saudi Arabia, Iraq), Africa, Central Asia. Bejel, is caused by Treponema pal- lidum similar to the one that sexually transmitted (syphilis) disease, but transmission is very different. It is transmitted by direct con- tact, with broken skin or contaminated hands, or indirectly by sharing drinking vessels and eating utensils. The skin, bones, and mucous membranes are affected by bejel commonly. Bejel was commonly found among Bedouin [Arab = desert dwellers], primari- ly nomad Arab peoples of the Middle East, where they form about 10% of the population. The World Health Organization has worked in Iraq in 1951 to control this and other diseases by organized projects. Widespread use of penicillin has been responsible for reducing the number of existing cases, The teams of WHO recommended that the only way to eliminate bejel is by improving living and sanitation conditions. Key Words; Bejel Disease, Endemic Syphilis, History of Medicine, Iraq.
Health Services in Early Twentieth disease was either included in the same category of Century in Iraq venereal disease or under the skin disease. Health services were poor in general, few small hospitals in Iraq at that time. Bejel was widespread WHO Control Project amongst the tribes of the Western Desert and the Campaigns were organized by the Regional south marsh area, in Iraq. Before the foundation of Office in Alexandria (WHO) in 1951 (4). These the Bejel Institute in 1951, patients with skin and included projects such as Bejel control. Malaria, venereal diseases were treated in the Department of Leprosy, T.B. and subsidiary projects. The details of Skin and Venereal Disease attached to a main hospi- the agreement for Bejel control was that; According tal, Civil General Hospital in Baghdad (1-3). This to .reports of the Iraqi and foreign experts to the hospital was originally built in 1872 by Midhat WHO, concerning the prevalence of Bejel in Iraq, an Pasha to commemorate the visit of Nasr Al-Din agreement was signed in 1952 for controlling Bejel Shah. After the departure of the Turks in 1917 British and V.D. The WHO would send specialized experts, troops entered Baghdad and the hospital was repaired UNICEF would supply medicine and other medical and re-equipped. In 1920 there was a venereal dis- equipment. The Iraqi government would be responsi- ease dispensary which dealt with the sexually trans- ble for providing medical staff, administration staff mitted diseases. Reviewing the Annual Health and all maintenance costs and expenses. The inci- administration reports of 1920 to 1949, I was unable dence of Bejel was estimated to be not less than half to find any terminology related to Bejel despite the a million. fact that the disease was prevalent in the region (1-4). It was reported in 1928 in the Syrian Desert (5), also The Institute of Bejel in 1936 by Iraqi doctor Wadad (1n Arabic) (6); in The Institute of Bejel and V.D. was established in 1940 by Hoff and Shabby (7) and by Akrawi in 1949 Baghdad in the summer of 1951. In its first year it (8). From annual statistics it appears that the Bejel was run by doctors from Iraq, Britain, France and
56 JISHIM 2004, 3 CONTROL PROJEST OF BEJEL (ENDEMIC SYPHILIS) Kathem K. AL-RUBIAY DISEASE IN IRAQ America, but Iraq is took over the administration of 1. Clinical cases of Bejel the Institute for the subsequent years (4). The 2. Contacts Institute staff was comprised of a director, six assis- 3. Infected pregnant women tant doctors, six nurses, six dressers and a number of During the early days of the project the team met laboratory technicians and X-ray staff. From these with many difficulties due to the ignorance of the personnel three teams were organized. The first team patients and their disgust at giving away some of was stationed in the northern area, the second team their blood for the purpose of serological examina- was stationed in the middle area and the third team tion, and because of their attitude towards Bejel, was in the southern area. They were provided with which they considered a. simple matter requiring no transport, often a car, but in the Western desert hors- treatment (4). Those difficulties were eventually es and camels were used, boats were used in areas overcome. As a result, a large number of patients where rivers made water transport preferable. The were cured. The normal treatment was penicillin, 1.2 Institute also ran two V.D. dispensaries in Baghdad. mega units in a single injection for the early stage, Specimens from the field were sent to a modern lab- but a double dose for the late stages (10). The oratory so the serological analysis could be carried Institute, apart from treating Bejel. also treated vene- out (4,9). real diseases and other skin diseases. The Institute expanded gradually and in later years it became a Foreign Medical Advisers For the Project place for teaching medical students. After the At the suggestion of WHO and the request of the Revolution of July 14, 1958. The Institute was Iraqi government, the first adviser to the Bejel proj- renamed the Unit of Dermatology and Venereology ect was Dr. Hudson who took up his residence in after the control project and was attached to the main Baghdad in October 1950. After preliminary hospital (9). The people however, still called it the research, field work started on January 1st, 1951. The Bejel Institute. first two months were spent on the Euphrates River, then a few weeks with the nomads of the Western Results of the Project Desert. After that, two months were spent in the During 1951 the investigation and control meas- marsh area in the south. On June 1st, 1952, the teams ures were restricted to certain Liwas (provinces). began work on the northern part of the Tigris River. Work in other cities started in 1952 when three teams Dr. Hudson left Iraq in mid-June, and replaced by Dr. were formed. The control project started in early G.W. Csonka as Adviser for project. During that time 1953 and continued until the end of 1955. It covered he investigated 3000 cases and published his results 11 province in Iraq except few provinces which were in two papers, the first entitled Bejel. Childhood to be included in the control program of 1956. The Treponematosis and the second entitled Clinical team found the incidence of the disease to be very Aspects of Bejel (10,11). He was followed by Dr. high (between 60 to 90%) especially 1n the villages L.G.G. Jones who became Chief Adviser for the near Deir-Ez-Zor -such as TalaaFar and Sinjar (4,9). WHO project in 1953. He reported a very rare case In 1956 there was a follow-up of the same vil- caused by Bejel (12) .disease under the name lages, and the incidence was found to be greatly Mutilating Bejel reduced. In 1957-1958 the teams doing the control and follow-up operation covering all the villages, Achievements of the Institute including cottages, and schools, found that the num- The Institute discovered that the best way for ber of active cases became less, especially in schools. controlling Bejel was by attending the patients in Factors contributing to the eradication in active cases their own remote districts, in spite of the great diffi- included the opening of new schools, dispensaries, culties confronting the traveler, due to the very poor widespread ownership of radio, propaganda cam- roads. On their visits to a village the teams consid- paigns and large companies all influenced people to ered the following: become more health conscious. The total number of
JISHIM 2004, 3 57 Kathem K. AL-RUBIAY CONTROL PROJEST OF BEJEL (ENDEMIC SYPHILIS) DISEASE IN IRAQ people investigated at follow up during 1959 were between either Bejel and syphilis, or Yaw and 33169 and in 1960 were 57139, but the teams found Bejel (14,18). that the number of acute cases were very greatly 2. The epidemiological point. reduced, apart from sporadic cases (9). This disease was prevalent amongst the Bedouins, the semi Bedouins, the inhabitants of the The conclusion of the teams that the Bejel disease Euphrates and Tigris River basins and around the was under control at that time. However, some cases Arab peninsula (5,18). remain in the village predominantly inhabited by the 3. The nomenclature of Bejel which is a local name nomadic Bedouins. Control in these villages was not used by Arabs, which as previously mentioned 100% effective because of their nomadic nature. The means sore. From the time it was first reported teams recommendation on the eradication of this dis- in 1928 it was used in medical literature because ease was to improve the standard of living with the of its significance both from a medical and epi- medical care for sporadic cases (9). demiological point of view. It was differentiated from venereal syphilis as far as the Bedouins were Discussion concerned (13,18). It is clear that Bejel was a local name introduced 4. The antiquity of the disease was puzzling but by the Bedouin Arabs of the Euphrates. It has certain some villagers in Iraq used other names such as clinical and epidemiological aspects. The disease lowath, jirdam and these are mediaeval words commonly affected children and adolescents, and used by Arab people. In view of the fact that some was not related to sex; mainly it affected the mucous Bedouins used mercury for treating the disease, membrane, skin and bones. one can conclude that the disease existed in Story of Bejel is significant from the standpoint of ancient time (13). medical history and it is the subject of concern to all 5. The significant of WHO work campaigns and the who are interested in the history of medicine, espe- affect of penicillin in eradicating the disease by cially the history of syphilis, as it appears to be linked one or two injections (10). (13-17). 6. It is interesting to note that several reported cases in other parts of the world have been made of a In 1982, I met Dr. R.R. Willcox, when he lectured disease like Bejel but are not exactly identical to on Tropical Treponematosis to students on the course Bejel as found in the Arab world. of venereology, London. I asked him if he had any The reports came from (1) South of Persia idea about the history of this disease and how it came (Csonka, 1951); (2) South Rhodesia (Willcox, to Iraq. His answer was that the subject was not stud- 1951) called Njovera; (3) East Africa (Manson- ied with this point of view. There was no definite Bahr, 1941); (4) Turkey (Willcox. 1951); (5) information, and he did not know how the disease Bechuanatand (Murry, 1935) called dichuchwa came to that region. On inquiring from doctors R.D. (15,19). Catterall and W.A.A. Griffiths, I was given the same 7. Lastly, we are not sure if the disease may relapse answer. I have collected my information about this and appear in another form or it may occur as a disease from previous literature and reports in Arabic modified version. As far as I am aware no further and English, from personal connections. I feel the research has been carried out in Iraq and the pres- historical study of this disease is important because: ent situation is such that the disease is under con- 1. The relation of this disease to other treponematosis. trol. This problem was not solved in spite of the fact that the disease had been considered eradicated REFERENCES completely. This point is clear if I mention what 1. Reports of the General Health Inspector. Department of Dr. C.J. Hackett said, That still he found it diffi- Health Services; Government of Iraq , for Years 1920-1926. cult to visualize exactly what Bejel was like also 2. Der Nagopian MK. Public Health in Iraq: The First Half- Dr. Hudson said There is no clear cut difference Century. (Arabic) Baghdad: Government Press,1981.
58 JISHIM 2004, 3 CONTROL PROJEST OF BEJEL (ENDEMIC SYPHILIS) Kathem K. AL-RUBIAY DISEASE IN IRAQ
3. Reports of Public Health Directorate. Ministry of Interior; 13. Al-Rubiay KK. The History of Bejel Diseases in Iraq. Government of Iraq, Vital Statistical for a Year 1935 . Diploma Thesis in History of Medicine London, 1982. 4. Annual Bulletin of Health and Vital Statistical. Ministry of 14. Hackett CJ.: On the Origin of the Human Treponematosis. Social Affairs ; Government of Iraq, for Years 1950-1952 . Bull World Health Organ 1963; 29:7-41. 5. Hudson E.H.: Treponematosis among the Bedouins Arab of 15. Walker DH, Guerrant RL, Weller PF. Treponemal Infec- the Syrian Desert. Nav. Med. Bull. 1928; 26:817. tions. In: Guerrant RL, Walker DH, Weller PF, eds. Tropical 6. Wedad. Is Bejel Yaws? (In Arabic). Baghdad, Iraq: Infectious Diseases: Principles, Pathogens, and Practice. Government Press,1936. New York, NY: Churchill Livingstone, 1999: 527-34. 7. Koff AB, Rosen T: Nonvenereal treponematoses: yaws, 16. Garrison F.H. History of Medicine, 4th Edition. Philadel- endemic syphilis, and pinta. J Am Acad Dermatol 1993 Oct; phia Saunders,1929. 29(4): 519-35. 17. Guthre D. History of Medicine. London and Edinburgh: 8. Akrawi F.: Is Bejet Syphilis? Brit. J. Vener. Dis.1949; 25:115. Thomas Nelson and Sons,1945. 9. Annual Bulletin of Health and Vital Statistical. Ministry of 18. Hudson E.H. Non Venereal Syphilis as Sociological and Health; Government of Iraq, for Years 1953-1960. Medical Study of Bejel. Edinburgh and London: E & S 10. Csonka G.W. : Bejel; Childhood Treponematosis. Brit. J. Livingstone, 1958. Ven. Dis. 1952; 6: 401. 19. Chulay JD. Treponema Species (Yaws, Pinta, Bejel). In: 11. Csonka G.W. : Clinical Aspects of Bejel. Brit. J. Ven. Dis. . Long SS, Pickering LK, Prober CG, eds. Principles and 1953; 29: 45. Practice of Infectious Diseases. New York, NY: Churchill Livingston; 2000: 2490-94. 12. Johnes L.G.G.: Mutilating BejeT, Brit. J. Vener. Dis. 1953; 29:104.
JISHIM 2004, 3 59 History of Endoscopy*
Mostafa SHEHATA*
* Prof.Dr., Otolaryngology, Faculty of Medicine Alexandria University, Alexandria, Egypt e-mail : m_shehataahoo.com
Summary Endoscopy by its different routes and techniques has very much widely opened the way to visualise all the body passages, cavi- ties and hollow organs. It has come to the present state of excellence through the improved visual access into these dark areas. Through the application of developments of the physics of optics, endoscopy has entered into a period of rapid expansion, new information and new therapeutic techniques. This made different lesions and foreign bodies well visualised and properly managed, with a high degree of efficiency. Key Words; Endoscopy, History of Medicine.
Since early time, man tried hardly to visualise the guided by the index finger to pass through the larynx. inside of the human body, through the natural open- He aimed to help patients of stridor to have better res- ings and passages of the body. Due to lack of suffi- piration (2). cient anatomical knowledge, facilities and technolo- gy it was very difficult or even impossible. The 19th Century Early History Through the subsequent centuries and the European renaissance nothing was added to the Early trials appeared 5000 years ago in ancient progress of endoscopy. Early in the 19th century Egypt during the process of mummification of the primitive metal endoscopic instruments appeared and dead persons, where they used a rigid metal tube were used for the diagnosis of the different lesions of passed through the nose to its upper part to pierce the the upper respiratory tract. cribriform plate to the cranial cavity to evacuate its content (1). The earliest and the first endoscopic instrument were the laryngoscope. The primitive type was a sim- The subsequent trial appeared 2000 years later ple silver tube illuminated proximally by a candle when Hippocrates (460-377 B.C), the great Greek and the light is reflected by a mirror, invented by physician tried to help a poor shepherd suffering Philip Bozzini in Frankfurt in 1807 (3,16). from respiratory distress due to a large peritonsillar abscess. He advised him to pass a hollow stick pipe Benjamin Babington improved this in 1829 using to the oropharynx and breathe through it, till he evac- reflected sunlight (4). uated the abscess. A procedure considered an early A modified instrument was later described by primitive rigid endoscopy for therapeutic purpose (2). Ludvig Türk in Vienna in 1858, and Johann Czermak in Prague in 1858 and Adolph Kusmaul in 1869 (4,5). The 10th Century Alfred Kirstein later perfected this in 1895, who Late in the 10th Century, during the early Islamic developed the first direct laryngoscopy (3-5). period a new endoscopic trial appeared. Avicenna (980-1034), the eminent physician of the middle age It should be noted that the study of diseases of the period advocated intubation of the larynx, using a larynx and hypopharynx was greatly stimulated by curved metal tube made of gold, passed orally and the invention of the laryngeal mirror for indirect
60 JISHIM 2004, 3 HÝSTORY OF ENDOSCOPY Mostafa SHEHATA laryngoscopy in 1855 by Manuel Garcia, a singing The last discovery in the 19th century was the inven- teacher in Spain who succeeded in examining his tion of the laryngeal stroboscope by Max Joseph Oertel own larynx by the aid of two mirrors and the reflect- in 1895, which helped the visualisation of the vibrating ed sunlight (5). vocal cords, in a slow motion movement (17). Oesophagoscopy appeared slightly later, after an th interesting observation of Adolph Kussmaul (an The 20 Century internist) in Freiburg, Germany, who observed care- Early at the beginning third of this century at 1902 fully the demonstrations of sword swallowed and the Chevalier Jackson in America has clearly demon- extended neck position in relation to the trunk during strated all forms of distally illuminated rigid laryngo- its swallowing. In this way he performed the first scopes, bronchoscopes and oesophagoscopes as well oesophagoscopy in 1868, with the aid of reflected as the telescopes. This has opened the way for the light (6). clinical and pathological study of the different lesions and the removal of foreign bodies from the respirato- Once, this progress was achieved in Europe, the ry and food passages (5,6). first clinic of laryngoscopy was established in 1870 in Vienna, as the first clinic of this speciality in the The early telescopes that were presented by world. Schrotter Von Kristelli was appointed the head Jackson consisted of a series of small lenses separat- of this clinic (17). ed by air spaces to help increase in viewing angle and magnification. Gustav Killian, in Freiburg, Germany, demon- strated the first bronchoscopy in 1898 using a rigid Hopkins, the British optical physicist added the modified oesophagoscope inserted though a tra- telescopic rod lens system, that allows more light, cheostomy wound (5). wider viewing and greater magnification (6). This allowed more endoscopic diagnostic and therapeutic A practical oesophagoscope with distal illumina- procedures. tion was devised later and practised by Chevalier Jackson in 1902, and at the same time he presented In few years Jackson had many skilled assistants and had very efficient staff who occupied six chairs also the distally illuminated bronchoscope introduced in this speciality (5). through the mouth (5). New endoscopic tubes with proximal illumination near the handle of the endo- During the second third of this century the princi- scope were presented by Haslinger while Saint Clair ples of Lamm, that developed in 1930 in the trans- introduced a third type in which two lamps are set mission of an image through the coherent bundle of obliquely in the walls of the tube (14). small flexible glass threads had permitted the devel- opment of the early flexible endoscopes (6). Endoscopy of the urinary tract started also very early in the 19th century, when Philip Bozzini, the Hirschowitz and his associates applied the fiber urologist in Frankfurt, Germany, did his early trails optic principle to the gastroscope in 1958 (6). for urethral examination in 1804. Ikeda and his team as well as others applied it to Once Thomas Edison developed the electric lamp bronchoscopy and oesophagoscopy in 1958 (6,7). in 1878 it opened the way for illuminated endo- The advantages of the fiber-optic endoscopes are scopes. Max Nitze was able in 1879 to present the many. They added to the extent of visualization, first distally lighted cystoscope, utilising a platinum washing brushings, curettage and biopsy. In bron- wire filament cooled by circulating water (5,6). choscopy they carried examination further to the Felix Guyon and his pupil Albarron of the late periphery of the lungs (6). 19th century invented the cystoscope for urethral Endoscopic documentation appeared in 1942 when catheterization, that has very much helped the Holinger presented his camera, that can work through progress of renal, vesical and urethral surgery (5). the bronchoscopes and oesophagoscopes (6,8).
JISHIM 2004, 3 61 Mostafa SHEHATA HÝSTORY OF ENDOSCOPY
Marsh contributed to early detection of bron- 1. Otolaryngology: the pioneer speciality using chogenic carcinoma by photography through fiber - endoscopy, rigid and flexible endoscopes. optic bronchoscope in 1973 (6,9). Laryngoscopes, Bronchoscopes, Oesophagoscopes, Rayl's work, allowed coloured television docu- Nasopharyngoscopes, Stroboscopes, Sinoscopes mentation (6). and Otoscopes. The last two are of the rigid types. 2. Chest Surgery: Rigid and flexible Bronchoscopes. The best additions are those achieved by Ward Rigid Thoracoscopes and Mediastinoscopes. and others using the Hopkins rod lens telescope with 3. Abdominal Surgery: Rigid and flexible the surrounding fiber - illumination and an antifog Oesophagoscopes, Gastroscopes, Duodenoscopes, airflow system (6). Colonoscopes, Choledochoscopes, Rectosigmoi- Microscopic larygeal surgery, with the advantage doscopes, Proctoscopes, Labaroscopes. The last of more magnification, excellent exposure, binocular two are always rigid types. vision, brilliant illumination and bimanual instru- 4. Gynaecology: Rigid endoscopes as mentation was added in 1968, under the leadership of Hysteroscopes, Culdoscopes, Labaroscopes and Kleinsasser, Ono, Saito, Jako and Strong (6, 10-12, 17). Flexible Fallopioscopes. 5. Urology: Rigid and Flexible Cystoscopes, Laser surgery of the larynx and bronchi has been Urethroscopes, Ureteroscopes, Nephroscopes and introduced by Strong and Jako in Boston, America in Labaroscopes. 1972, with the advantage of the precise removal of 6. Orthopaedic Surgery: Rigid type Arthroscope (= lesions of the vocal cords, trachea and bronchi (13,17). Jointscope). The last third of this century witnessed a great 7. Neuro-Surgery: Rigid type Encephaloscope. progress in the production of endoscopic material 8. Plastic Surgery: Rigid small endoscopes in face with new manufactural specifications, variable acces- lift surgery. sory instruments and efficient methods of documen- By time more medical specialities are on the way to tation (18). use the endoscopes for more efficient and careful diag- The endoscopic tubes and their instruments are no nosis and treatment of the different body diseases. more named after the names of their inventors but carrying the trade name of the manufacturing firm. REFERENCES Nowadays there are large leading companies pro- 1. Ghaliongui and El Dawakhly. The Preservation of the Body. ducing the endoscopic equipment on a large commer- In: Health and Healing in Ancient Egypt. Cairo, Egypt: Dar cial scale in Japan, Germany, United State of America, El-Maaref, 1965: 31. 2. Sercer A.: Tracheostomy Through Two Thousand Years of Britain, France, Italy and many other countries. History. Ciba Symposium Journal, 1962; 10(2): 78. Surgical and medical indications for endoscopy 3. Alberti P.W.: The Evolution of Laryngology and th are continuously increasing for diagnostic, medical Laryngectomy in the Mid. 19 Century. The Laryngoscope Journal, U.S.A., 1975:85-288. and surgical purposes (18). 4. Singer C., Underwood A. Short History of Medicine. 2nd New fields for endoscopy have been introduced edition U.K.: Oxford Clarendon Press, 1962: 249. not only through the natural passages of the body but 5. Arturo Castiglioni. A History of Medicine. Translated from Italian and edited by E.P. Krumbhaar, second edition. New also through surgical openings in the abdomen, chest, York: Alfred Knopf, 1958: 874-1029. skull and other different body organs. 6. James Snow. Broncho-oesophagology. Chapter 58. In: Diseases of the Nose, Throat and Ear, edited by John Jacob Most of the present medical and surgical speciali- Ballenger, 12th edition. Philadelphia: Lea and Febiger, ties consider endoscopy a good effective method in 1977: 997. their field and is performed regularly in their medical 7. Ikeda S.: Flexible Bronchofiberscope. Ann. Otol. Rhinol. practice. Laryngol. 1970; 89: 916. 8. Holinger P.H.: Photography of the Larynx, Trachea, The following shows an updated enumeration of the Bronchi and Esophagus. Trans. Amer. Acad. Ophthalm. endoscopes used in the different medical specialities. Otolaryng. 1942; 46: 153.
62 JISHIM 2004, 3 HÝSTORY OF ENDOSCOPY Mostafa SHEHATA
9. Marsh B.R. et al. Flexible Fiber Optic Bronchoscopy. Its 15. Messerklinger W. :Die Endoscopie der Nose Mschr. Ohr. Place in the Search for Lung Cancer. Trans. Am. Branch. HK, 1970: 104, 451-456. Oesophageal. Assoc. 1973: 101-110. 16. Miller R.A.: Endoscopic Instrumentation, Evolution, 10. Kleinsasser O. Microlaryngoscopy and Endolaryngeal Physical Principles and Clinical Aspects. British Medical Microsurgery. Philadelphia: W.B. Saunders & Co. 1968. Bull. 1986, 41: 223-225. 11. Ono J. and Saito S.: Endoscopic Microsurgery of The 17. Luickhaupt H. The History of Laryngology in Europe. Larynx". Ann. Otol. Rhinol. Laryngol. 1971; 80: 479. Proceedings of the First Scientific Conference of the European Laryngological Society, Marburg, Germany 26, 12. Strong M.S.: Microscopic Laryngoscopy, A Review and 29, September 1996. Appraisal. Laryngoscope 1970; 80: 1540. 18. Bernard Marsh. Endoscopy of Tracheo-Bronchial Tree and 13. Strong M.S., Jako H.J.: Laser Surgery in the Larynx. Ann. Esophagus. In: Charles Cummings and others editors. Otol. Rhinol. Laryngol., 1972; 81: 791. Otolaryngology, Head and Neck Surgery Chapter 121. sec- 14. St. Clair Thomson. Diseases of the Nose and Throat. 6th ond edition, Vol. 6, Mosby Year Book, St. Louis, U.S.A., edition. London: Cassell and Company LTD, 1955: 845. 1993: 2229.
JISHIM 2004, 3 63 The Story of Bejel Disease in Iraq: Bejel (Endemic Syphilis) Disease Among the Euphrates Arab Bedouins*
Kathem K. AL-RUBIAY*
* DHM, DTMH MSc. PhD., Department of Dermatology, Collge of Medicine, University of Basrah - Basrah, Iraq Po. Box. 289 e-mail : [email protected]
Summary This paper is primarily intended for the historical aspect of Bejel (endemic syphilis) disease in Iraq. Bejel (the Arabic word for the disease) is an infectious disease a form of endemic syphilis which is not sexually transmitted and occurs in children. It was most commonly found in the Middle East (Syria, Saudi Arabia, Iraq), Africa, central Asia, and Australia. This disease was prevalent among the Bedouins of the West Desert and the peasants people of villages of the Tigris and Euphrates Rivers prior to the 1951 WHO cam- paigns in Iraq also among Bedouins of Syrian Desert. Bejel has many synonyms as sibbens (Scotland), radseyege (Scandinavia), siti (Gambia), therlijevo (Croatia), njovera (Southern Rhodesia), frenjak (Balkans), dichuchwa (Bechuanatand). The disease has other col- loquial names in Arabic local languages as Bishal, Lowath, Balash and Jirdam, but amongst the medical profession it was known as "non-venereal syphilis" or "endemic syphilis". The organism that causes bejel belongs to the same family as the that causes syphilis, named the treponema Bejel is characterized by the skin and bones lesions that begin in the mouth and progress gradually to the late stages which are the most severe. The disease is usually occur in childhood and spreads in a non-venereal way. It was believed that when the disease entered a village it spread, to all occupants of the village, suggesting an easily communicable disease. The Bedouins description of the disease was similar to measles (a common childhood disease). If a child escaped infection, then the likelihood of contracting it in adulthood was almost cer- tain and the Bedouins were able to distinguish the Bejel eruption from those of chicken pox, small pox or measles. Dr. Hudson, who has the first notified of this disease in medical literature in 1928 from the city of Deir-Ez-Zor in Syria. Also it was widely believed that the disease was transmitted from Syria to Iraq. I hope it will be of value to overview the historical story of this disease which is considered to have been theoretically and prac- tically eliminated from Iraq as previous observers and writers have concentrated mainly in the clinical features, diagnosis and treat- ment of Bejel disease. Key Words; Historical Aspect of Bejel, Endemic Syphilis, Iraq.
Background in summer; cold and wet in winter. The two largest This background information is necessary rivers are the Tigris and the Euphrates. The Euphrates because Bejel is considered to be found mainly passes through the Syrian Desert before entering Iraq amongst the Arab Bedouins and has certain geo- through the West Desert to reach to the south of Iraq. graphical distribution, climatic conditions, and life The peasants in the marsh area of Iraq at the style considered to be important factors in the spread beginning of this century were poor, simple and pre- of the disease. dominantly farmers and fishermen, boats are the Iraq is situated on the South-western part of Asia main method of transport. They build their houses and occupies the north eastern part of the Arab which were usually cottages or mud huts along the Homeland. Bordered by Turkey to the north; Iran to bank of the small rivers. On the other hand the the east; Jordan, Saudia Arabia and Syria to the west; Bedouins lived in 'black-tents' mainly in the Western Kuwait and Saudia Arabia to the south. Mountains Desert. They were poor; camels being the main form are in the north and north-east, while the south is of transport. Drinking water came from the rivers or mainly marshland. Western desert in the west (form- wells; their lifestyle differed radically from towns- ing 60%) expanding towards the Syrian Desert and people. There was no veneral disease as was in the the Arab Peninsula. The climate of Iraq is hot and dry towns, due to their customs and the fact that they
64 JISHIM 2004, 3 THE STORY OF BEJEL DISEASE IN IRAQ: BEJEL (ENDEMIC SYPHILIS) Kathem K. AL-RIBIAY DISEASE AMONG THE EUPHRATES ARAB BEDOUINS married at an early age, usually between 14 to 16 Origin of Bejel years old. The Bedouins move around many times (Epidemiological Theories) during the year according to the weather. They go Medical historians of Bejel were puzzled by the where the rain falls and where there is grass for their absence of ancient information and writers failed to animals. The incidence of Bejel amongst the describe it in the old medical writings (5). The origin Bedouins at one time affected 90% of them. The of Bejel is uncertain; whether it originated in the Bedouins were similar to the peasants in that they had Arab area or whether the disease was brought from neither schools nor dispensaries and other diseases other regions by mass migration, slave trade, wars, were prevalent, such as malaria, malnutrition and commerce, or pilgrimage is unknown. tuberculosis (1,2). We know the first who mentioned Bejel as a dis- Deir-Ez-Zor is virtually an oasis in the Syrian ease in medical literatures was Dr. Hudson in 1928 Desert. It is important to mention these notes for two under the title 'Treponematosis among the Bedouins reasons: (a) It is situated near the Western border of Arabs' (3). The following theories and hypothesis Iraq. It was believed that the Bejel entered Iraq may help to explain the nature of Bejel disease. through the their tribes emigrating from Deir-Ez-Zor. (b) Bejel was first reported from this region in med- Unitarian Theory ical literature in 1928 (2-8). When the first clinic was opened by the 'American Presbytarian Mission' in This theory explains the evolution of treponemato- Deir-Ez-Zor in 1924, Dr. Hudson, who was in charge sis in the world and it states that all pathogenic tre- of this clinic, studied this disease and he collected the ponemes have common ancestors, as free-living organ- knowledge about the disease from the patients who isms adapted themselves to man as commensals and as came to the clinic (3-5). a result of natural selection, climatic conditions, domestic life and may be slight mutation resulting Discovery of Treponema from accidental fault in the DNA genetic code produce a variety of lesions (12-14). It was suggested by It may be useful to mention some of general consid- Hackett (1963) that the first disease was Pinta or 'the erations about the discovery of Treponema and the var- blue stain disease", this disease was distributed ious forms of diseases caused by it. In 1905 Schaudinn throughout the world (14). Further, Hackett considered with Hoffmann discovered the organism of syphilis (6- that Pinta gave rise to Yaws in Africa and the disease 7). They named it spirochaeta pallido 'pale spiral hair'; was transmitted by "skin to skin' contact; the warm but later he found that this name was also being used humid climate was a contributory factor to transmis- for other geneses of the same family. Finally, he chosed sion. Further more, endemic syphilis (Bejel) evolved the term Treponema twisted thread. Diseases caused by from yaws; the climatic conditions in the Arab world subspecies of the pathogenic treponemes are are such that it is warm during the day and cold at night Treponema pallidum (syphilis), Treponema pertenue and although the skin was protected by clothes. (yaws), Treponema endemicum (bejel or endemic Spreading of the disease due to many factors such as syphilis), and Treponema carateum (pinta) (8-10). kissing, communal use of eating and drinking utensils. Some considered Bejel the same as the yaws of The Arab Bedouins had similar customs lead to the subtropics. Indeed, this idea had been advocated by result that the disease spread rapidly and involved Wadad in 1936 of Basrah - Iraq (11), but no support mucous membrane, especially in the mouth. According was given to this idea. Other writers and observers to this theory, venereal syphilis evolved from endemic considered Bejel as a form of endemic syphilis syphilis as socio-economic level and better hygiene, amongst the Arab Bedouins and peasants around the and the result was sexually transmitted. Euphrates, and is caused by Treponema pallidum. Also it is a disease found in primitive rural areas Colombian Theory affecting all ages, mainly children, with no relation to This theory explains the spread of syphilis to sexual activity (3,8-10). Europe in 1494 from the West Indies. Members of the
JISHIM 2004, 3 65 Kathem K. AL-RIBIAY THE STORY OF BEJEL DISEASE IN IRAQ: BEJEL (ENDEMIC SYPHILIS) DISEASE AMONG THE EUPHRATES ARAB BEDOUINS crew of Christopher Columbus' ship acquired exporting gold, ivory and slaves (12,16). After the syphilis from local women and developed a rashes Muslim conquest of Africa, slave trading continued called 'Indian Measles'. Some of the crews later and reached its peak at the end of the 7th century AD. became mercenaries in 1494 at the Siege of Naples, The slave war which occurred in Iraq in 869 AD was where a great epidemic broke out. However, this the- called the revolt of the Zanj. This was a war between ory does not explain the evolution or origin of the Negro slaves from East Africa who were forced to endemic syphilis (6,7,12). work in the salt mines. There was no evidence that slaves transmitted tre- Role of Wars and Pilgrimage ponema to the Middle East, but one can conclude The first Crusade (AD 1096-1099) believed to these mass migrations from regions of Africa where have consisted of 250,000 fighting men with an equal treponema was prevalent. Their transportation may number of servants, camp followers, and women cap- have also transported the organism. The first trepone- tured Jerusalem and entered a Syrian Villages'. So ma to be introduced to the Caribbean from Africa marked an increase in leprosy was reported. But later came in 1502 with the first Negro slaves. Its inci- archaeological evidence showed that many lepers dence increased after 1512 with the spread of slave were in fact suffering from syphilis (14,15). trading and commerce. This may explain the role of Islamic conquest stretched throughout the world slaves in spreading of treponema. It seems reasonable during and after the time of the Prophet Mohammed. to apply this assumption to slave trading and com- These conquests extend from Spain to Samarkand. merce in the Middle East. The first pilgrimage to 'Mecca' undertaken by the Prophet Mohammed in 632 AD. After that, Islamic The Antiquity of the Bejel in Arab pilgrimages attracted people from all over Africa, Homeland Asia, and other places. It also mentioned that Mecca The origin of Bejel is unclear, and there is no had been an object of reverence for 200 years before direct evidence but some considered Bejel the arche- the time of Prophet Mohammed, because of its sacred type of syphilis or the prototype of non-venereal stone and its designations as the legendary site where syphilis in the ancient Arab homeland around the Abraham dismissed his wife, Hajar and her son Euphrates region. The ancient world was predomi- Ismmael. Another mass migration by Mongols was to nantly rural; the majority of its habitants probably Mesopotamia where the Mongol troops sacked lived under conditions similar to those of Euphrates Baghdad in 1258 AD. Arab in the early part of this century. It may be there- This process of migration through pilgrimages, fore that the Bedouins are presenting contemporary Islamic conquests, and Crusades wars from all parts picture of syphilis as it existed in ancient time in non- of the world in the course of time might have played venereal. Some support for this view comes from the a major role in the dissemination of Treponema. WHO campaign in Iraq in 1951. The teams found that some villages used other names for Bejel dis- Slave Trading and Commerce ease. Some Bedouins in the West Desert in Iraq Throughout the line of history there have been called it 'Lowath', other villagers in the south called it slaves and slave trading. Slaves were captured from 'Jirdam', in other places in Iraq they called the disease various regions of Africa and shipped across oceans just 'leprosy'. Both lowath and jirdam are ancient or driven across the Arab desert to Asia Minor and mediaeval words introduced in Mesopotamia and the other countries. At the time of the pre-Christian era, meaning of these terms was leprosy and its use to Ethiopia was a collecting point for African slaves for describe chronic ulcerative lesion might also include Arabs. Migrating Arabs came from the east across the Bejel disease. Leprosy was mentioned in the Bible, and in ancient medical records, it was prevalent Red Sea to the Horn giving the Ethiopians horses, throughout the world (6,7). camels and grapes, and receiving in return coffee and Negro slaves. In Africa was also the richest ports for Four characteristics of ancient leprosy which
66 JISHIM 2004, 3 THE STORY OF BEJEL DISEASE IN IRAQ: BEJEL (ENDEMIC SYPHILIS) Kathem K. AL-RIBIAY DISEASE AMONG THE EUPHRATES ARAB BEDOUINS would include syphilis and other treponematosis suf- Summary of Clinical Aspect of Bejel fering under the heading of leprosy are: (a) In ancient Bejel diseases a similar clinical feature of syphilis Mesopotamia it was said that "if lepers were kept with few differences (8-10). The onset mainly during away,people would not get the disease" (5). Also the childhood, 25% of cases before the age of 6 years and Old Testament quotes the story of Naaman, 'the leper' 66% of cases before the age of 16 years. Sex ratio who was told by Eli'sha to wash himself seven times was female slightly over male 1.1:1. The incubation in the River Jordan. Another point was, that lepers period unknown, other suggested that it was similar were segregated in leper homes, 'lazar', and buried in to syphilis. There is a possibility that insect vector special cemeteries. From the above it is clear that the may play a role in the transmission of this disease this disease with which they were concerned was highly was suggested by for two reasons; first, most cases contagious; as we know leprosy is not highly infec- were near the marshes, and second, fresh infectious tious and needs long periods for many years, whilst cases appeared in spring and summer when insects the incubation period of syphilis ranges between 9 to and flies were numerous. 90 days; therefore, not all patients in ancient time were necessarily suffering from leprosy, perhaps Clinical stages: this consist of the following; some were cases of syphilis or other treponematosis. 1 - Early stage or primary lesion (b) During the Crusades, the concept of 'venereal lep- 2 - Latency stage rosy' gradually developed and we since know that it 3 - Late stage is more true of syphilis, which is a sexually transmit- ted disease. (c) It was also mentioned that a child Early Stage: Mucous patches: commonly seen in could be born with "leper" or congenital leprosy, this, the mouth. and may be the first manifestation. Skin like (b), is not true for leprosy but is true for syphilis. lesion: generalised skin eruption, resembling the (d) The Arabs used mercury from the earliest time; lesion in syphilis .Skeletal involvement mainly mercury was a well known ancient remedy for lep- ostealgia and osteoperiostitis rosy and was recorded in ancient writing. Also The Latency Stage: The patient may become a reported in the early part of this century was the fact symptomatic at any time especially within the first that the Bedouins in both the Syrian Desert and Arab four years of the disease. The result of this stage is Peninsula used mercury inhalation as a method of that one third of the patients become a symptomatic, treating the Bejel (2). Mercury has no effect on lep- and only serologically positive. rosy, but has effect against treponematosis (5). This supports the longevity of Bejel in the Arab area. Late stage: The findings consist of skin gumma- ta which is common manifestation. The nasopalatal Indigenous Idea destruction, resulting in the saddle nose ,the skeletal changes as in early stage. Other rare findings like pig- The physicians in Deir-Ez-Zor said that trepone- mentary change ,juxta-articular nodules and hyperk- ma was brought to the region by Egyptian troops eratosis. There were controversial questions not set- under the command of Ibrahim-Ali in the 19th centu- tled at that time. The questions were whether this dis- ry; probably through troops having sexual relations in ease could involve the cardiovascular system or the the city and as a result venereal syphilis occurred in nervous system and whether congenital disease can townsmen and was called 'Franji'; this disease may occur as in venereal syphilis. Hoff and Shabby (1940) have spread to rural areas, amongst tribes and the reported two cases from the Royal Hospital in Bedouins in a non-venereal method and the result Baghdad with nervous involvement (17). was a disease called 'Bejel, which locally means in Arabic, 'sore'. Iraqi physicians suggested that Bejel Rhahim and Akrawi (1951) reported aortitis in a was brought to Iraq by tribes emigrating from Deir- Bejel patient (18). Ez-Zor in Syrian Desert which a neighbor of Iraqi Lab Studies: Endemic syphilis should be suspect- Bedouin in the West Desert to Iraq. ed in persons with chronic skin or bone lesions who
JISHIM 2004, 3 67 Kathem K. AL-RIBIAY THE STORY OF BEJEL DISEASE IN IRAQ: BEJEL (ENDEMIC SYPHILIS) DISEASE AMONG THE EUPHRATES ARAB BEDOUINS
Table 1. Showing the comparison between yaws, syphilis and 2. Hudson EH.: Bejel Endemic Syphilis of the Euphrates Bejel. Arabs Trans. R. Soc. Trop. Med. Hyg 1937; 31:9. 3. Hudson EH: Treponematosis Among the Bedouins Arab of Lesions Yaws Bejel Syphilis the Syrian Desert. Nav. Med. Bull. 1928; 26:817. 4. Al-Rubiay KK. The History of Bejel Diseases in Iraq. Global Tropical Local World wide Diploma Thesis in History of Medicine London, 1982. Socio- Low, rural Like yaws All grad 5. Hudson EH. Non Venereal Syphilis as Sociological and economic Medical Study of Bejel. Edinburgh and London: E & S Climate Hot, wet Hot a day, All climate Livingstone, 1958. climate...... Primary Extragenital Like yaws Usually genital 6. Garrison FH. History of Medicine, 4th edition. Philadelphia lesion Saunders,1929. Mucous Not affected Affected Like bejel 7. Guthre D. History of Medicine .London and Edinburgh: membrane Thomas Nelson and Sons,1945. Itching Common Like yaws Rare 8. Chulay JD. Treponema Species (Yaws, Pinta, Bejel). In: Alopecia Unknown Like syphilis May occur Long SS, Pickering LK, Prober CG, eds. Principles and Eye Not affected Like yaws Common Practice of Infectious Diseases. New York, NY: Churchill C.V.S. Not Like yaws Affected Livingston, 2000:2490-94. C.N.S. Not Like yaws Affected 9. Koff AB, Rosen T: Nonvenereal Treponematoses: Yaws, C.S.F Negative Often positive Usually positive Endemic Syphilis, and Pinta. J Am Acad Dermatol 1993 Affect of No response Response Response well Oct; 29(4): 519-35. mercury 10. Walker DH, Guerrant RL, Weller PF. Treponemal Infections. Gongosa Not rare Like yaws rare In: Guerrant RL, Walker DH, Weller PF, eds. Tropical juxta-articular Not rare Like yaws rare Infectious Diseases: Principles, Pathogens, and Practice. nodule; New York, NY: Churchill Livingstone, 1999: 527-34. Depigmen- Not rare Like yaws rare 11. Wedad. Is Bejel Yaws? In Arabic. Baghdad, Iraq tation :Government Press,1936. Causative T. pertenue T. pallidum T. pallidum 12. Robertson, DHH., McMi11on A., Young H. Clinical organism Practice in Sexually Transmissible Diseases, 1980. live in endemic areas. Confirmation of the diagnosis 13. Mandell GL, Bennett JE, Dolin R: Treponema Pallidum (syphilis). Principles and Practice of Infectious Diseases depends on dark-field examination and on specific 2000; 2474-90. and non specific serological tests for syphilis. 14. Hackett CJ: On the Origin of the Human Treponematosis. Bull World Health Organ 1963;29:7-41. Treatments: Treatment is based on single-dose 15. Hudson EH: Treponematosis and Pilgrimage. Amer. J. Med. antibiotic therapy with benzathine penicillin. Sci. 1963; 35: 645. Treponemes are highly sensitive to penicillin, which 16. Scott HH: The Influence of the Slave Trade in the Spread of remains the drug of choice for syphilis. Tropical Diseases. Trans. R. Soc. Trop. Med. Hyg 1943; 38:169. 17. Hoff H., Shabby J.: A Nervous Manifestation of Bejel. REFERENCES Trans. R. Soc. Trep. Med. Hyg. 1940; 33:54. 1. Der Nagopian MK. Public Health in Iraq: The First Half- 18. Akrawi F., Rahim GF.: Aortitis in Bejel in Iraq. Brit. J. century. (Arabic) Baghdad: Government Press,1981. Vener. Dis.1951; 27: 95.
68 JISHIM 2004, 3 AN ANDALUSIAN MUSLIM SCIENTIST: IBN AL-BAYTAR Rosanna GORINI An Andalusian Muslim Scientist: Ibn al-Baytar
Rosanna GORINI*
* Institute of Neurosciences-Lobaratory of Psychobiology and Psychopharmacology, C.N.R., Rome, Italy e-mail: [email protected]
Summary Spanish Muslims gave the greatest contributions to botany as an outgrowth of medicine. Abu Muhammad Abd Allah Ibn Ahmad Dhiya al-Din Ibn al-Baytar al-Malaki is considered, among them, one of the most important scientists. A brief profile of him is traced in this paper also with reference to Kitab al-Jami' li-mufradat al-adwiyah wa-al-aghdhiyah, one of his main treatises. Key Words; Ibn al-Baytar, Botany, Pharmacology, Kitab al Jami
In the history of arabic science botany and agri- Ibn al-Baytar was born in the Muslim Spanish culture, in the classification of sciences, have been city of Malaga or in its neighbourhood, most proba- for a long time considered as a single discipline. bly at the end of the 12th century, between 1190 and Given the prominence of plants in the treatment of 1197. He came from a family of a great scientific tra- illness, they are sometimes classed among the med- dition which, coming from Granada, settled in ical sciences. Malaga. According to some authors he probably belonged to the family of the same name whose exis- Botany has progressively separated itself from tence in Malaga is attested by Ibn al-Abbar or, agriculture, especially under the influence of Greek according to F.J. Simonet, he came from a Spanish sources (e.g. Theophrastus (372-288A.D.), Dioscoride family, called Bono or Bueno. His grandfather Abu (ca. 40-90 A.D.), translated into Arabic (1). Surely Marwan Abd al-Malik Ibn al-Baytar arrived very Arabs paid special attention to the Greek natural sci- young in Malaga where he spent all his life. His ences such as botany and pharmacy and Greek materia father, Ahmad b. 'Abd al-Malik, a veterinarian, con- medica was a major common basis for Arab Islamic veyed to Ibn al-Baytar, since his childhood, the pas- medicine and pharmacy which in turn led to the mod- sion for plants, animals and minerals together with ern pharmaceutical therapy (2). However, although the interest in the pharmacological use of the simples. "pharmacology in Medieval Islam is based on the Ibn al-Baytar lived his first years in Malaga and ancient Greek tradition, the original Arabic contribu- probably, between 18 or 20, he moved to Seville. tion to the introduction and employment of new sub- Here he studied with the best botanic teachers of the stances is undeniable" (3). Spanish Muslims gave the period, Abd Allah Ibn Salih, Abu-l-Hadjdjadj and greatest contributions to botany, as an outgrowth of particularly with Abu-l-Abbas al-Nabati (the medicine and so far some of them are known as the botanist, nicknamed Ibn al-Rumiyya) with whom he greatest botanists and pharmacists of medieval times. started collecting plants and learnt to distinguish and Looking for rare botanical herbs they roamed about identify their numerous species. In this period Ibn al- mountains, coastlines and in far lands. They classified Baytar widened and improved his theoretic and prac- plants into those growing from seeds, from cutting and tical studies in the field of botany, always concerning those growing on their own accord. In this paper we'll the pharmacological use of the simples (4). After the try to outline a brief profile of one of the main Arab leaving of his teacher al-Nabati for Orient, Ibn al- botanists and pharmacologists, Abu Muhammad Abd Baytar spent few years in Andalusia and, in about Allah Ibn Ahmad Dhiya al-Din Ibn al-Baytar (the son 1220, he left Spain beginning a scientific travel of the veterinarian) al-Malaki (born in Malaga), more toward the East herborizing and carrying out scienti- often known as Ibn al-Baytar. fic observations and covering the same route previ-
JISHIM 2004, 3 69 Rosanna GORINI AN ANDALUSIAN MUSLIM SCIENTIST: IBN AL-BAYTAR ously covered by his teacher. He also gathered botan- the Kitab al-Jami' li-mufradat al-adwiyah wa-al- ical materials in view of their possible pharmacolog- aghdhiyah (The comprehensive Book on Materia ical use. In this journey he was accompanied by Ibn Medica and Foodstuffs) gives a summary of the phar- abi Usaybi'a, one of the most valuable of his pupils macological knowledges of his time. It consists of an who reports that, during their naturalistic travels, they alphabetically ordered dictionary in which foods and brought with them the books of Dioscoride, Galen simple medicaments from the animal, plant and min- (ca. 130-200 A.D.), al-Ghafiqi (12th c.) and other eral kingdoms are reported and can be considered the similar authors. It is possible to reconstruct the itiner- largest pharmacological encyclopedia still surviving ary of this travel from the informations given by the at our times. In order to write this book Ibn al-Baytar same Ibn al-Baytar in his treatises (5), also if it is not based himself on many authors, especially Greeks possible to know exactly the modes of his travel. He authors as Dioscorides, Galen, Aristotle (384-322 moved to Ceuta, in Morocco, and hence he arrived in B.C.), Hippocrates (460-377 B.C.), Oribase (325-403 Algeria, at Bugìa. Then he moved again, arriving in A.D), Rufus of Ephesos (late Ist c. B.C-half 1st c. Constantinople through Tunis, Tripoli and Barca. A.D.), Paul of Egina (625-690 A.D.) but also Persian, From the South coast of the Asia Minor, about 1224, Indian, Sirian Chaldean and Arab Muslim authors, passing through Iraq and Persia, Ibn al-Baytar among which Razes (ca. 864-930 A.D.) and Avicenna moved to Syria and, later, to Egypt. Here, according (980-1037 A.D.). He also based himself on many to some authors, he observed for the first time botanic and agricultural works and on the work, hashish being eaten. The main users of the drug, he today lost, of his teacher al-Nabati (13th c. A.D.) and noted, were the Sufis. "People [i.e. the Sufis] who use of Abu Hanifa al-Dinawari (ca. 815-895 A.D.), con- it [hashish] habitually have proved its pernicious sidered by some historians the founder of the Arabic effect," he writes, "for it enfeebles their minds by car- botany (1). rying to them maniac affections and causing some- Kitab al-Jami' can be considered one of the main times death." Ibn al-Baytar then adds: "I recall hav- reference works for the history, the botany, the phar- ing seen a time when men of the vilest class alone macology, the medicine and also for the language of dared to eat it, still they did not like the name takers its time. It is of special interest for the linguists of hashish applied to them (6, 7). because, where possible, Ibn al-Baytar reports the In Egypt he entered as "chief of the herbalists" the Greek, Berber, Persian and Latin names of the plants service of the Ayyubid Sultan al-Malik al-Kamil, who (10). It seems important to underline that the cohe- ruled over this country from 1238 to 1240 and in the sistence in this book of foreign languages represents same period over Syria. After the death of al-Kamil, an unprecedent occurrence among the Arab Muslim Ibn al-Baytar lived a little longer in Palestina and scientific works. Syria. Here he did some herborization on the moun- Ibn al-Baytar treatise can be considered the basis tains where the flora was more rich than in Egypt and of many subsequent manuals concerning medicinal after he returned to Egypt (8), where he continued to substances, as that written in the 18th century by the work with the son of the precedent Sultan al-Malik practitioner in India Muhammad Husayn ibn al-Salih who ruled from 1240 to 1249 and to whom Muhammad Hadi al-Aqili al'Alavi (11). Even if Ibn he dedicated his main works (5). al-Baytar has been known in the Western countries Ibn al-Baytar died in Damascus between October only in the 19th century, his works and mainly the and November 1248. Considered by some authors the work we have considered in this brief profile, have greatest Muslim botanist and by others only the made possible to consider him as one of the most greatest compiler of pharmacological books in the important scientists in the field of botany and medi- Arabic world (9), Ibn al-Baytar devoted his very cine of his time and his contributions have exerted a extensive literary production prevalently to botany profound influence on Eastern as well as Western sci- and pharmacology. One of his most important books, ence.
70 JISHIM 2004, 3 AN ANDALUSIAN MUSLIM SCIENTIST: IBN AL-BAYTAR Rosanna GORINI
REFERENCES 7. Walton RP. Marijuana Philidelphia: J. B. Lippincott, 1938: 13. 8. Meyerhof M.: Esquisse d'histoire de la Pharmacologie et 1. Toufic Fahd: Botany and Agriculture. In: Encyclopedia of botanique chez le Musulmans d'Espagne. In: Johnstone P. the History of Arabic Science. Vol. III, 1996: 813-852. Editor. Studies in Medieval Arabic Medicine. Theory and 2. El-Gammal SY: The relation between Greek and Islamic Practice. Variorum Reprints London, 1984, X, 1-41. materia medica. Bull. Indian Inst. Hist. Med. Hyderabad 9. Cabo Gonzales AM.: Ibn al-Baytar et se apports à la 1997 Jan.; 27(1):39-46. botanique et à la pharmacologie dans le Kitab al-Gami. 3. De Maio D.: Psychiatric therapy and pharmacology in Médiévales, 33, Autumne 1997:23-39. medieval Islam. Med Secoli. 2002;14(1):39-68. 10. Mrad BB.: La Méthode de traitment des termes botaniques 4. Cabo Gonzales AM.: Ibn al-Baytar in: Enciclopedia de al- et pharmacologiques chez Ibn-al-Batar. In: Coopération Andalus. Diccionario de obras y autores andalusies, Tomo entre la langue arabe et la langue française, Conseil I, Direccion J. Lirola, Y.J.M. Puerta. Granada, 2002:619-624. International de la langue française, 82-97. 5. Cabo Gonzales AM.: "Kitab al Yami li-mufradat al-adwiya 11. Tschanz DW.: A Short History of Islamic Pharmacy. Journal wa-l-agdiya. Colección de Medicamentos y Alimentos". of the International Society for the History of Islamic Mergablum. Edición y Comunicación, Sevilla, 2002. Medicine, 2003; 2(3):11-17. 6. Rosenthal F. The Herb. Leiden: E.J. Brill, 1971: 97-98
JISHIM 2004, 3 71 CONGRESS AND SOCIETY NEWS
ABOUT INTERNATIONAL SOCIETY H. E. Dr. Hajar Al Binali FOR THE HISTORY OF ISLAMIC Dr. Abdul Nasser Kaadan MEDICINE AND ITS MEETINGS Dr. Hussain Nagamia Dr. Faisal Al-Nasir International Society for the History of Islamic Dr. Nil Sari Medicine (ISHIM) provides the researches in the Dr. Mostafa Shehata field of Islamic Medicine and supports the projects Dr. Mehdi Mohaghegh about the Islamic History of Medicine. Furhermore, it Mr. Ali Al Suwaidi also studies the dilemmas of medical ethics in the Dr. Ayesgul Demirhan Erdemir - Chief Editor of Islamic countries. Journal of the International Society ISHIM for the History of Islamic Medicine (JISHIM) is its publication organ and it is indexed to the History Dr. Ibrahim Shaikh - Advisor for Islamic Journal.De, a German scientific index. This journal is Medicine Museum published in English twice a year. The founder mem- Dr. Khalifa Al Jaber bers of this society is well-known medical historians In this meeting, the date of future congress of of the world. ISHIM and its regulation will be discussed. The first meeting of ISHIM was held in Doha on Moreover, a symposium will be made in Doha on December 2, 2000 in Dr. Hajars office in Womens January 30, 2005. The speakers of this symposium Hospital and attended by the following members: are as follows: Dr. H.A. Hajar Al-Binali Dr. Abdul Nasser Kaadan, Dr. Husain Nagamia: Medical Education, Health Dr. Husain Nagamia Administration and Delivery of Health During the Dr. Faisal A. Latif Alnasir Early Islamic Period Dr. Sharif Kaf Al-Ghazal Dr. Mostafa Shehata: Honoration of Physicians Prof. Dr. Nil Sari Through the Past Ages Dr. Mostafa Shehata Dr. Mehdi Mohaghegh Dr. Nil Sarý: Foundation of the Medical History Dr. Rachel Hajar Museum The meeting was also attended by the treasurer Dr. Aysegül Demirhan Erdemir: Traditional Mr. Ali Al Suwaidi and the Public Relations Officer Treatments with Natural Drugs and Some Samples Mr. Salim Al Muhanadi. Dr. Faisal Alnaser: History of Infant Feeding The following issues were discussed and neces- Dr. Abdul Nasser Kaadan: Some of Arab and sary actions taken: Muslim Physicians Achievements Attributed to 1. Approval of the minutes of the first meeting. Western Physicians 2. Approval of By-laws 3. Approval of the Logo ABOUT SOCIETY FOR MEDICAL 4. Approval of the application form. ETHICS AND LAW 5. Opening Account with Qatar National Bank Society for Medical Ethics and Law was estab- Second Meeting of the Executive Board Members lished in Istanbul on December 3, 2004. Its regulation of ISHIM and a Symposium will be made during was accepted on February 11, 2005. This society January 29-30, 2005 at Doha Sheraton Hotel in Qatar. aims to help the development of the scientific Following Executive Board Members will partic- researches, to support the scientific activities, to help ipate in this meeting. the modernization of the education of the medical
72 JISHIM 2004, 3 ethics and medical law and to provide the internation- coordinate the international meetings in the al scientific relations in the fields of medical ethics fields of medical ethics and medical law to and medical law. The society has 17 founder mem- transfer scientific developments in this field in bers. Societys Logo with serpent and scales has been foreign countries to Turkey and the related designed by painter Jale Yavuz. developments in Turkey to other countries when necessary. Society has the international characteristics and i) To cooperate and coordinate the scientific rela- in order to achieve these objectives, it shall perform tions with other national and international sim- the following activities: ilar and relevant entities to invite guest a) To follow and encourage the scientific researchers in accordance with the 5th article research on medical ethics and medical law in and conditions of the Law for Associations and Turkey and in the world. in the order projected by the regulations. b) To help solving the problems of the medical ethics and medical law in the health founda- tions, to provide assistance to the official 1. SYMPOSIUM ON MEDICAL authorities and educational institutions about ETHICS AND LAW (27 May 2005) the subjects indicated in the aims section. WITH INTERNATIONAL c) To help to provide postgraduate education in the fields of medical ethics and medical law PARTICIPATION with the aim of helping the people working in This symposium is the first activity of Society for the health branch to deal with the problems Medical Ethics and Law. The aim of this society is to they may face when they are providing health develope scientific researches, to support education services. of medical ethics and law and to provide internation- d) To perform the national and the international al scientific relations in the field of the medical ethics scientific projects and researches in the fields and law. Society for Medical Ethics and Law will of medical ethics and medical law. hold the symposium with the collaboration of Turkish e) To provide the print of the international scien- Society for History of Medicine and Istanbul tific journal as the publication organ if a finan- University, Medical School, Department of Medical cial source can be found. Ethics, Cerrahpasa Medical School, Department of f) To provide the possibilities in order to train the Medical Ethics, Uludag University, Medical School, researchers in the fields of medical ethics and Department of Medical Ethics, Istanbul University, medical law and to support the scientific proj- Faculty of Law, Department of Penal Law and ects of the researchers from abroad on Turkish Criminal Procedure Law in Istanbul. The aims of this medical ethics and medical law. symposium are to enlighten all the colleagues on g) To hold the national and the international con- medical ethics, medical law and patients rights. gress, symposium, panel and meetings in the Known colleagues from Germany, Switzerland, field of medical ethics and medical law. Belgium and Croatia are to participate in this sympo- h) To provide the scientific relations with foreign sium. societies, institutes and universities and to
JISHIM 2004, 3 73 SCIENTIFIC EVENTS
The First International Maimonides Conference 2nd Bursa Folk Culture Symposium on Medicine and Ethics It will be held in Bursa, Turkey on October 20-22, It will be held in Tiberias-Israel on March 20-24, 2005. 2005. Uludað Üniversitesi Rektörlüðü Contact Address: Kültür Sanat Kurulu 16059 Nilüfer-Bursa-Turkey 1 Nirim Street (P.O.B. 9352) Tel: (0.224) 442 80 067442 80 41 Tel Aviv 61092, ISRAEL Faks: (0.224) 442 90 44 Tel: +972-3-6384444 E-mail: [email protected] Fax: +972-3-6384455 [email protected] E-mail: [email protected] Website: www.ortra.com/maimonides An International Joint Bioethics Congress Inter- Cultural Bioethics, Asia and West The First Symposium on Medical Ethics and Law It will be held in Sanlýurfa, Turkey on November 14- with International Participation 18, 2005. It will be held in Ýstanbul on May 27, 2005 Contact Address: Contact Address Assoc. Prof. Dr. Þahin Aksoy Prof. Dr. Ayþegül Demirhan Erdemir HarranUniversity, Faculty of Medicine, E-mail: [email protected] Department of History of Medicine and Medical Ethics, Þanlýurfa. The XXth Nordic Medical History Congress e-mail:[email protected] It will be held in Reykjavik, Iceland on August 10-13, th 2005. 9 National Congress on the Turkish History of Medicine Contact Address: Iceland Travel Conference Department It will be held in Kayseri, Turkey on May 24-26, Lagmuli 4 P.O. Box 8650 2006. IS-128 Reykjavik- Iceland Contact Address: Tel: +354 585 4300 Dr. M. Mümtaz Mazýcýoðlu Fax: +354 585 4390 Erciyes University, Faculty of Medicine E-mail: [email protected] Department of Family Medicine Website: www.lis.is/saga 38039-Melikgazi/Kayseri-Turkey Tel: (0.352) 437 49 37- 23 852- 23 850 3rd Meeting of the International Society for the Gsm: 0 533 549 80 55 History of Medicine Faks: (0.352) 437 76 15 It will be held in Patra, Greece on September 11-14, E-mail: [email protected] 2005. Sezer Erer Contact Address: Uludag University, Faculty of Medicine, Department Conference Organizers of History of Medicine and Medical Ethics-Bursa- Ermineia, Gounary 37, Patra, 26 221, Greece. Turkey Tel: +0030 226 530 e-mail:[email protected] Fax: +0030 226 530 E-mail: [email protected]
74 JISHIM 2004, 3 40th International Congress on the History of Ms Klara Papp Medicine 1051 Budapest, Nador u. 7 HUNGARY Tel: 36-1-327-3000/2538 It will be held in Budabest, Hungary on August 26- Fax: 36-1-411-6370 30, 2006. E-mail: [email protected] Contact Address: Website: www.ishm1006.hu Hungarian Academy of Sciences Office for International Cooperation
JISHIM 2004, 3 75 76 JISHIM 2004, 3